Individual
MS. KATHLEEN GAIL IVANOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, TLLP
Contact information
Practice address
496 W ANN ARBOR TRL, SUITE 202, PLYMOUTH, MI 48170-6262
(248) 613-5377
Mailing address
2403 CRYSTAL DR, ANN ARBOR, MI 48108-1111
(734) 320-2719
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301014954
MI
Other
Enumeration date
06/29/2012
Last updated
06/29/2012
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