Individual
MRS. KELLY DZIEDZIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
8397 FAWN MEADOW TRL, GALESBURG, MI 49053-7745
(269) 760-0660
Mailing address
8397 FAWN MEADOW TRL, GALESBURG, MI 49053-7745
(269) 760-0660
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361004240
MI
103TC1900X
Counseling Psychologist
6361004240
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1708146
—
MI
Enumeration date
05/21/2008
Last updated
03/31/2024
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