Individual
JON SCOTT WEELDREYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LLP
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301008797
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P10C976540
BC/BS
MA
Enumeration date
08/04/2006
Last updated
07/08/2007
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