Provider Demographics
NPI:1083765812
Name:CRAMER, KATHLEEN JANDERNOA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JANDERNOA
Last Name:CRAMER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4205 BAYWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2288
Mailing Address - Country:US
Mailing Address - Phone:616-957-7807
Mailing Address - Fax:616-949-5336
Practice Address - Street 1:967 SPAULDING AVE SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3700
Practice Address - Country:US
Practice Address - Phone:616-464-3424
Practice Address - Fax:616-949-5336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013342103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical