Individual
JESSICA VAN WALLEGHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16137 LEONE DR, MACOMB, MI 48042-4063
(586) 566-0326
Mailing address
409 BELANGER ST, GROSSE POINTE FARMS, MI 48236-3201
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12478682-4201
MI
225X00000X
Occupational Therapist
Primary
12478682-4201
UT
Other
Enumeration date
05/20/2019
Last updated
04/08/2026
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