Organization
MICHIGAN STATE UNIVERSITY CLINICAL CENTER
Active
Organization
MICHIGAN STATE UNIVERSITY CLINICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA ZALDOKAS (MGR PROVIDER ENROLLMENT)
(517) 355-3503
Entity
Organization
Contact information
Practice address
804 SERVICE RD STE A114, EAST LANSING, MI 48824-7038
(517) 355-7648
(517) 432-1319
Mailing address
804 SERVICE RD STE A114, EAST LANSING, MI 48824-7038
(517) 355-7648
(517) 432-1319
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301014684
MI
103T00000X
Psychologist
6301006498
MI
Other
Enumeration date
07/11/2011
Last updated
04/13/2012
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