Healthcare Provider Details

I. General information

NPI: 1760186696
Provider Name (Legal Business Name): JESSICA SPRINGSTEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 84TH ST SW
BYRON CENTER MI
49315-9344
US

IV. Provider business mailing address

1431 JENNETTE AVE NW
GRAND RAPIDS MI
49504-3021
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-0631
  • Fax:
Mailing address:
  • Phone: 231-736-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: