Healthcare Provider Details

I. General information

NPI: 1952120412
Provider Name (Legal Business Name): JENNIFER ANN POPPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN HAUK

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WASHINGTON AVE
BAY CITY MI
48708-5846
US

IV. Provider business mailing address

823 S FARRAGUT ST
BAY CITY MI
48708-7302
US

V. Phone/Fax

Practice location:
  • Phone: 989-684-7977
  • Fax:
Mailing address:
  • Phone: 989-890-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: