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General NPI Number Information
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NPI Number | 1821306051
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Entity Type | Individual
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Provider Name | MARIAN KAYE PUFFER
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Gender | Female
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 1721 MOON LAKE BLVD SUITE 150
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-1069
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Country | US
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Telephone | 847-519-3650
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Fax |
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Provider Business Mailing Address
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Address Line | 8509 SURFSIDE DR
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City | MONTAGUE
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State | MI
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Zip | 49437-8434
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301007710
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License Number State | MI
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