Doctor Name: | MRS. JAIME LYNN WETZEL |
NPI Number: | 1689884165 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | 6301013112 |
Business Practice Address: | 2077 Edward Ln W Kimball, MI - 480741922 |
Business Phone Number: | 8103677763 |
Business Fax Number: | |
Mailing Address: | 2077 W, Edward Ln., KIMBALL |
State: | MI |
Postal Code: | 48074 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 6301013112 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |