Healthcare Provider Details

I. General information

NPI: 1598379877
Provider Name (Legal Business Name): JENNIFER BAAS LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 MONROE AVE NW STE 100
GRAND RAPIDS MI
49503-6714
US

IV. Provider business mailing address

3608 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-9171
US

V. Phone/Fax

Practice location:
  • Phone: 616-916-3711
  • Fax:
Mailing address:
  • Phone: 616-323-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009360
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: