Individual
RAYMOND PAUL HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LLP
Contact information
Practice address
1013 PARCHMENT DR SE, GRAND RAPIDS, MI 49546-3664
(616) 974-0901
(616) 974-0923
Mailing address
1013 PARCHMENT DR SE, GRAND RAPIDS, MI 49546-3664
(616) 974-0901
(616) 974-0923
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301011394
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BC/BS
P10C976540
MI
Enumeration date
06/30/2006
Last updated
01/30/2008
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