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NPI Code Detail

MEDICARE: DR. JANELLE MARIE YOUNGDAHL PHD

MEDICARE: DR. JANELLE MARIE YOUNGDAHL PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6351004233MI
2103TC0700XClinical Psychologist6301019162MI

General Provider Information

NPI Number : 1841800067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JANELLE MARIE YOUNGDAHL PHD
Provider Business Mailing Address
First Line : 4690 FULTON ST E
Second Line :
City : ADA
State : MI
Zip : 49301-8454
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4690 FULTON ST E
Second Line :
City : ADA
State : MI
Zip : 49301-8454
Country : US
Telephone Number : 810-225-3417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2020
Last Update Date : 03/22/2023

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