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General NPI Number Information
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NPI Number | 1811219272
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Entity Type | Individual
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Provider Name | KELLY NIERGARTH
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Gender | Female
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 5816 W US HIGHWAY 10 SUITE C
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City | LUDINGTON
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State | MI
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Zip | 49431-2450
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Country | US
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Telephone | 231-843-4899
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Fax | 231-843-8929
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | LAMONT
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State | MI
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Zip | 49430-0068
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014326
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6301014326
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License Number State | MI
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