Individual
KELLY MARIE SPEGEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1055 GEZON PKWY SW, WYOMING, MI 49509-9542
(616) 773-2908
(616) 532-3046
Mailing address
1055 GEZON PKWY SW, WYOMING, MI 49509-9542
(616) 773-2908
(616) 532-3046
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016993
MI
Other
Enumeration date
11/19/2015
Last updated
01/04/2024
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