Individual
IAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLP
Contact information
Practice address
1870 LEONARD ST NE, GRAND RAPIDS, MI 49505-5650
(616) 945-9619
(616) 956-8033
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301015260
MI
103T00000X
Psychologist
6361002052
MI
Other
Enumeration date
10/24/2012
Last updated
03/28/2024
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