Individual
JORDAN CHARLES ENGELHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DLLP
Contact information
Practice address
17325 VAN WAGONER RD, SPRING LAKE, MI 49456-9702
(616) 847-5145
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301015358
MI
Other
Enumeration date
10/24/2012
Last updated
10/24/2012
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