Individual
DR. DEBBIE KOELTZOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDD, LP
Contact information
Practice address
810 E GRAND RIVER AVE, #101, BRIGHTON, MI 48116-1878
(810) 588-4236
(810) 588-4247
Mailing address
2460 CARRIAGE WAY, YPSILANTI, MI 48197-7423
(734) 657-8059
(810) 588-4247
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301011430
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143449
VALUE OPTIONS
MI
01
—
382695674
PPOM
MI
01
—
68OH113370
BC/BC OF MICHIGAN
MI
Enumeration date
07/10/2007
Last updated
04/27/2009
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