Kristin M Mecklenburg, MA LLP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6361005978 Issued in MI

Practice address

4175 Parkway Place Dr SW Ste 100
Grandville, MI 49418-2382

Phone

(616) 371-5166

NPI assigned

Mar 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stange Clinic, PC

  • Clinical Psychologist
  • Grand Rapids, MI
  • NPI 1205564531
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1184683351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120125",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495280103",
            "telephone_number": "616-942-8060",
            "fax_number": "616-942-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 PARKWAY PLACE DR SW STE 100",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182382",
            "telephone_number": "616-371-5166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4467 Cascade Rd SE",
            "address_2": "SUITE 4475",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495463632",
            "country_code": "US",
            "telephone_number": "616-942-8060",
            "fax_number": "616-942-6690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MECKLENBURG",
        "first_name": "KRISTIN",
        "middle_name": "M",
        "credential": "MA LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361005978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esmeralda McLenithan
• Jennifer Lynn McNair
• Brandon William McNally, M.D.
• Brendan McNeilly, MD
• Meals on Wheels Western Michigan
• Leona Beth Meengs, MSN, RN, APRN, BC
• Meijer Inc
• Kristyn Joy Meines, CTRS
• Ryan Melcher, DPT
• Timothy James Mellus, O.D.

• Psychologist in Grandville, MI
• Providers in Grandville, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.