Individual
SOYAPONGA PROVIDENCE AMISI II
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2460 BURTON ST SE STE 101, GRAND RAPIDS, MI 49546-4800
(616) 278-1201
Mailing address
5068 RUM CREEK CT SE, KENTWOOD, MI 49508-5280
(616) 690-9731
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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