Healthcare Provider Details

I. General information

NPI: 1447734520
Provider Name (Legal Business Name): STEVEN JAHNKE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD NW STE 101
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

640 3 MILE RD NW STE 101
GRAND RAPIDS MI
49544-8209
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-8900
  • Fax: 616-785-8949
Mailing address:
  • Phone: 616-785-8900
  • Fax: 616-785-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010077
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: