Healthcare Provider Details

I. General information

NPI: 1801489562
Provider Name (Legal Business Name): CARLI JASPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 3 MILE RD NW STE 200
GRAND RAPIDS MI
49544-1691
US

IV. Provider business mailing address

3361 36TH ST SE
GRAND RAPIDS MI
49512-2809
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 616-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: