MEDICARE: JENNIFER JEANNE ELLIS M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401013557	MI

General Provider Information

NPI Number	:	1609180819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JEANNE ELLIS M.A.

Provider Business Mailing Address
First Line	:	7745 JONAGOLD DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-7602
Country	:	US
Telephone Number	:	800-435-2197
Fax Number	:

Provider Business Practice Location Address
First Line	:	7745 JONAGOLD DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-7602
Country	:	US
Telephone Number	:	616-970-4636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	11/15/2013

Similar Medicare Providers

1558178731 — SADIE BECERRA ORTEGA
Practice Location Address:

731 GRAND AVE LOT 135
PLATTEVILLE, CO
80651-7602

Practice Phone: 720-986-2474
Practice Fax:

1841135654 — LYRA LEE
Practice Location Address:

2013 EASTCASTLE DR SE STE B
GRAND RAPIDS, MI
49508-8873

Practice Phone: 616-888-1120
Practice Fax:

1093591091 — BRYSON JAMES PACHECO PA-C
Practice Location Address:

6690 CROSSINGS DR SE STE C
GRAND RAPIDS, MI
49508-7394

Practice Phone: 616-600-1885
Practice Fax:

1437693660 — LEIDY FOURNIER PA-C
Practice Location Address:

6690 CROSSINGS DR SE STE C
GRAND RAPIDS, MI
49508-7394

Practice Phone: 616-600-1885
Practice Fax:

1225973605 — KAYLEIGH MARIE SCHULZ
Practice Location Address:

1545 68TH ST SE STE 201
GRAND RAPIDS, MI
49508-7896

Practice Phone: 616-253-6097
Practice Fax:

1033054408 — MISS KHALIDHA DAVIS
Practice Location Address:

2013 EASTCASTLE DR SE STE B
GRAND RAPIDS, MI
49508-8873

Practice Phone: 616-888-1120
Practice Fax:

Directions to “ JENNIFER JEANNE ELLIS M.A.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.