Healthcare Provider Details

I. General information

NPI: 1356267504
Provider Name (Legal Business Name): JENNIFER JENSEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 WATERTOWN WAY
GRAND RAPIDS MI
49505-6049
US

IV. Provider business mailing address

2235 WATERTOWN WAY
GRAND RAPIDS MI
49505-6049
US

V. Phone/Fax

Practice location:
  • Phone: 810-348-8793
  • Fax:
Mailing address:
  • Phone: 810-348-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JENSEN
Title or Position: PRIVATE PRACTICE THERAPIST
Credential: LMSW
Phone: 810-348-8793