Healthcare Provider Details

I. General information

NPI: 1861045643
Provider Name (Legal Business Name): KATHERINE L JESTER TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2019
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 CASCADE RD SE STE 4479
GRAND RAPIDS MI
49546-3776
US

IV. Provider business mailing address

163 RIVER OAKS
PLYMOUTH MI
48170-1808
US

V. Phone/Fax

Practice location:
  • Phone: 616-264-5414
  • Fax:
Mailing address:
  • Phone: 616-745-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: