Individual
KAITLIN MARIE JOHANNSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548
(616) 281-6372
Mailing address
2611 WASHINGTON ST, PELLA, IA 50219-7924
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
090633
IA
Other
Enumeration date
04/28/2018
Last updated
08/20/2018
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