Provider Demographics
NPI:1710219159
Name:RUNKLE, MARGO CHRISTINE (JD, MA)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:CHRISTINE
Last Name:RUNKLE
Suffix:
Gender:F
Credentials:JD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9603
Mailing Address - Country:US
Mailing Address - Phone:269-615-2450
Mailing Address - Fax:269-428-3448
Practice Address - Street 1:4265 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9603
Practice Address - Country:US
Practice Address - Phone:269-615-2450
Practice Address - Fax:269-428-3448
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014399101Y00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor