Basic Information
| Provider Information | |||||||||
| NPI: | 1891091195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KUIPER ACT, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4829 E BELTLINE AVE NE | ||||||||
| Address2: | BLDG 1 SUITE 100 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495259747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165814668 | ||||||||
| FaxNumber: | 8663792151 | ||||||||
| Practice Location | |||||||||
| Address1: | 4829 E BELTLINE AVE NE | ||||||||
| Address2: | BLDG 1 SUITE 100 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495259747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165814668 | ||||||||
| FaxNumber: | 8663792151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2011 | ||||||||
| LastUpdateDate: | 02/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | KUIPER | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6165814668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301012952 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.