Individual
KELLY VANDERGIESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
2282 SPRINGPORT RD, JACKSON, MI 49202-1432
(517) 768-9791
Mailing address
1071 S COLLEGE RD, MASON, MI 48854-9707
(616) 291-2247
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101003528
MI
Other
Enumeration date
03/11/2022
Last updated
03/11/2022
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