Healthcare Provider Details

I. General information

NPI: 1477944692
Provider Name (Legal Business Name): ASHLEY JANSMA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 MICHIGAN ST NE STE 7
GRAND RAPIDS MI
49503-2028
US

IV. Provider business mailing address

805 LEONARD ST NE
GRAND RAPIDS MI
49503-1138
US

V. Phone/Fax

Practice location:
  • Phone: 248-894-8421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: