Healthcare Provider Details

I. General information

NPI: 1508754185
Provider Name (Legal Business Name): JONATHAN SALMONOWICZ LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 REMEMBRANCE RD NW STE 3
GRAND RAPIDS MI
49534-7745
US

IV. Provider business mailing address

237 IVES AVE SW APT 1
GRAND RAPIDS MI
49504-6079
US

V. Phone/Fax

Practice location:
  • Phone: 616-379-9191
  • Fax:
Mailing address:
  • Phone: 937-314-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: