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Individual

NICOLE H WYNGARDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
6500 BYRON CENTER AVE SW, BYRON CENTER, MI 49315-9080
(616) 281-6311
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301015679
MI
103TC0700X
Clinical Psychologist
6301015103
MI
103TC0700X
Clinical Psychologist
Primary
6301015679
MI

Other

Enumeration date
06/19/2012
Last updated
12/02/2024
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