Doctor Name: | MICHELLE KONYNENBELT |
NPI Number: | 1164890406 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 7101000925 |
Business Practice Address: | 1310 E Beltline Ave Se Suite 230 Grand Rapids, MI - 495064304 |
Business Phone Number: | 6165268947 |
Business Fax Number: | 6165268952 |
Mailing Address: | 1310 E Beltline Ave Se, Suite 230 GRAND RAPIDS |
State: | MI |
Postal Code: | 495064304 |
Phone Number: | 6165268947 |
Fax Number: | 6165268952 |
NPI Enumeration Date: | 09/03/2015 |
NPI Last Update Date: | 09/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7101000925 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
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 |