Individual
JACLYN RECKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
245 CHERRY ST SE STE 104, GRAND RAPIDS, MI 49503-4607
(616) 685-5050
(616) 685-8962
Mailing address
1900 44TH ST SE, KENTWOOD, MI 49508-5008
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301016942
MI
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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