Individual
DR. KIRSTEN NICOLE BONIFACIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
601 JOHN ST STE M-005, KALAMAZOO, MI 49007-5381
(269) 341-6350
Mailing address
3201 PINEHURST LN, GRAND BLANC, MI 48439-2606
(231) 557-7069
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301018888
MI
390200000X
Student in an Organized Health Care Education/Training Program
6352000204
MI
Other
Enumeration date
06/04/2020
Last updated
07/23/2021
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