Individual
DR. KATHLEEN PICCOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8668
(616) 840-9762
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8668
(616) 840-9762
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
0006030
CO
103T00000X
Psychologist
Primary
6301019499
MI
103TC0700X
Clinical Psychologist
6301019499
MI
Other
Enumeration date
08/03/2021
Last updated
02/03/2025
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