Healthcare Provider Details

I. General information

NPI: 1326572686
Provider Name (Legal Business Name): JACOB SAVAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4893 E BELTLINE AVE NE 310
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

4893 E BELTLINE AVE NE 310
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-279-6414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: