Healthcare Provider Details

I. General information

NPI: 1033897996
Provider Name (Legal Business Name): JENNIFER PARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SPRING MEADOWS LN
DEWITT MI
48820-9598
US

IV. Provider business mailing address

121 SPRING MEADOWS LN
DEWITT MI
48820-9598
US

V. Phone/Fax

Practice location:
  • Phone: 517-652-5200
  • Fax:
Mailing address:
  • Phone: 151-765-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6851115242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: