Individual
DR. MIRA CHARLOTTE JOURDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3361 36TH ST SE, KENTWOOD, MI 49512-2809
(616) 942-2522
(616) 956-3260
Mailing address
2626 BROOKLYN AVE SE, GRAND RAPIDS, MI 49507-3937
(248) 885-4992
(616) 825-6264
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
6301014267
MI
103TC0700X
Clinical Psychologist
Primary
6301014267
MI
Other
Enumeration date
07/13/2011
Last updated
08/25/2021
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