Individual
JEAN C RUSSNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LLP
Contact information
Practice address
854 S WASHINGTON AVE, HOLLAND, MI 49423
(616) 355-3926
Mailing address
602 MICHIGAN AVE, HOLLAND, MI 49423-4918
(616) 392-5141
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301012080
MI
Other
Enumeration date
02/08/2007
Last updated
09/22/2010
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