Healthcare Provider Details

I. General information

NPI: 1952480915
Provider Name (Legal Business Name): AMY LYNN JARCHOW PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 CHARLEVOIX DR SE STE 323
GRAND RAPIDS MI
49546-7092
US

IV. Provider business mailing address

3940 PENINSULAR DR SE STE 230
GRAND RAPIDS MI
49546-6187
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-0692
  • Fax: 616-458-8129
Mailing address:
  • Phone: 616-458-0692
  • Fax: 616-458-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: