Individual
KRISTINE BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
50258 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48317-1374
(586) 884-4714
Mailing address
50571 NEWCASTLE DR, CHESTERFIELD, MI 48047-1716
(586) 202-1426
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6362009234
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
813601247
1225583248
MI
Enumeration date
10/05/2020
Last updated
10/05/2020
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