Healthcare Provider Details

I. General information

NPI: 1932606019
Provider Name (Legal Business Name): JENNIFER KARLEEN DIGENNARO LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER KARLEEN ROSEMA

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKE DR SE STE 8
GRAND RAPIDS MI
49506-1673
US

IV. Provider business mailing address

3501 TUSCANY DR SE
GRAND RAPIDS MI
49546-7247
US

V. Phone/Fax

Practice location:
  • Phone: 616-446-6728
  • Fax:
Mailing address:
  • Phone: 616-446-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: