| Organization Name: | PEDIATRIC COUNSELING CENTER, LLC |
| NPI Number: | 1154583235 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JODI TEN BROEKE (OWNER) |
| Mailing Address: | 950 N 10th St Suite 200 Kalamazoo |
| State: | MI US |
| Postal Code: | 490096112 |
| Phone Number: | 2693726500 |
| Fax Number: | 2693726503 |
| NPI Enumeration Date: | 06/30/2008 |
| NPI Last Update Date: | 06/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |