Individual
ELIZABETH MARIE COYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 456-6571
Mailing address
854 N OTTILLIA ST SE, GRAND RAPIDS, MI 49507-3737
(616) 822-0701
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1051516432
—
MI
Enumeration date
12/22/2022
Last updated
12/22/2022
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