| Jacquelyn Kellogg, Llc | |
|
6018 Cornerstone Ct Sw Grandville MI 49418 | |
| (616) 340-1061 | |
| Not Available |
| Full Name | Jacquelyn Kellogg, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 6018 Cornerstone Ct Sw, Grandville, Michigan |
| Authorized Official Name and Position | Jacquelyn Kay Kellogg (PSYCHOLOGIST) |
| Authorized Official Contact | 6163401061 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacquelyn Kellogg, Llc 6018 Cornerstone Ct Sw Grandville MI 49418 Ph: (616) 340-1061 | Jacquelyn Kellogg, Llc 6018 Cornerstone Ct Sw Grandville MI 49418 Ph: (616) 340-1061 |
| NPI Number | 1023714409 |
|---|---|
| Provider Enumeration Date | 02/06/2023 |
| Last Update Date | 02/06/2023 |
| Certification Date | 02/06/2023 |
| Medicare PECOS PAC ID | 7911344932 |
|---|---|
| Medicare Enrollment ID | O20240326001042 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023714409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jacquelyn Kay Kellogg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861413668 PECOS PAC ID: 8820435845 Enrollment ID: I20240326001182 |
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