MRS. KELLY DZIEDZIC


Address: 7320 Garden Ln, Suite 106, Portage, MI 49002-4423
Phone: 2696124322

MRS. KELLY DZIEDZIC (NPI# 1821255423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1821255423
Entity Type Individual
Full Name MRS. KELLY DZIEDZIC
Credential LLP
Practice Address 7320 Garden Ln
Suite 106
Portage
MI 49002-4423
Mailing Address 7893 Foxwood
Richland
MI 49083-9717
Practice Telephone 2696124322
Enumeration Date 2008-05-21
Last Update Date 2012-01-27
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103T00000X Psychologist 6301013537 MI Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
MI 1708146 05

Other Providers KELLY DZIEDZIC

NPI Name Taxonomy Address Enumeration
1568437879 Kelly L Dziedzic Physician Assistant 1000 W 140th St Unit 201, Burnsville, MN 55337-4833 2006-02-21

Office Location

Street Address 7320 GARDEN LN
SUITE 106
City PORTAGE
State MI
Zip Code 49002-4423

Providers in the same location

NPI Name Taxonomy Address Enumeration
1598858409 Ces Consultation, P.C. Community/Behavioral Health 7320 Garden Ln, Suite 110, Portage, MI 49002-4423 2006-10-02
1740549120 Comprehensive Neuropsychological Services PC Clinical Neuropsychologist 7320 Garden Ln, Portage, MI 49002-4423 2012-05-07
1568737799 Jessica A Kerby Psychologist 7320 Garden Ln, Portage, MI 49002-4423 2012-03-21
1881967909 Lasondra Wayne Counselor 7320 Garden Ln, Suite 106, Portage, MI 49002-4423 2012-02-21

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1932604204 Susan Vandewalker Physical Therapist 8001 Angling Rd., Portage, MI 49002 2018-03-28
1134634934 Portage Chiropractic and Wellness Center Chiropractor 609 E. Centre, Portage, MI 49002 2017-12-04
1548620537 Patricia Eid Behavioral Analyst 1016 E Milham Ave, Suite 2, Portage, MI 49002 2016-03-03
1386045383 Pinnacle Senior Care of Kalamazoo, LLC Home Health 2725 Airview Blvd Ste 105b, Portage, MI 49002 2014-09-09
1104241611 Meredith Ayers Holland Behavioral Analyst 9616 Portage Road, Portage, MI 49002 2014-02-20
1619211919 Daketia L Thomas Massage Therapist 8314 Portage Rd, Suite D, Kalamazoo, MI 49002 2012-11-27
1831457142 Kinetic Kids, LLC Occupational Therapist 540 East Milham, Portage, MI 49002 2012-04-25
1154689404 Lauren Michelle Mattaliano Occupational Therapist 540 E. Milham Road, Portage, MI 49002 2012-04-24
1114219227 South Michigan Psychiatric Services LLC Psychiatry & Neurology 5390 Lovers Ln, Third Floor, Portage, MI 49002 2011-05-07
1174836316 Premier Neuropsychiatry Plc Psychiatry & Neurology 5930 Lovers Lane, Portage, MI 49002 2010-07-16
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Taxonomy Information

Taxonomy Code 103T00000X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist

Taxonomy Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Notes: Source: American Psychological Association [1/1/2007: modified definition]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1215593934 Letetsia Fox Psychologist 1400 W Milham Ave, Portage, MI 49024-1209 2019-05-17
1912209156 Shamika Hall Psychologist 7901 S 12th St Ste 201, Portage, MI 49024-3831 2010-11-19
1952597767 Jayne Fabry, Ptc Associates Psychologist 1651 W Centre Ave, Portage, MI 49024-6312 2007-09-15
1437342565 Emily Walker Sherwood Psychologist 1604 Timberlane Dr, Portage, MI 49024-5705 2007-08-22
1083727192 Lee Carlin Sanders Psychologist 10056 Woodlawn Dr, Portage, MI 49002-7207 2006-08-16
1235151333 Joyce Scully Psychologist 78 Ski Hill Rd, Portage, IN 46368-8719 2006-07-25
1033169008 Patricia Shull-blood Psychologist 5148 Lovers Ln, Suite 200, Portage, MI 49002-1572 2006-05-11
1649245655 Patricia Ann Lyman Psychologist 5220 Lovers Ln, Suite 120, Portage, MI 49002-1599 2006-02-22
1477530392 Michael V Bloom Psychologist 7920 Kirkland Ct, Portage, MI 49024-4974 2005-12-30
1598746778 James Darrell Cowart Psychologist 5100 Lovers Ln, Trestlewood, Bldg. D, Portage, MI 49002-1558 2005-11-07
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Competitor

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City PORTAGE
Zip Code 49002

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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