Healthcare Provider Details

I. General information

NPI: 1437332871
Provider Name (Legal Business Name): JEANETTE MCDOWELL FORREST LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GERTRUDE JEANETTE MCDOWELL

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 104
GRAND RAPIDS MI
49503-3261
US

IV. Provider business mailing address

233 E FULTON ST SUITE 114-C
GRAND RAPIDS MI
49503-3200
US

V. Phone/Fax

Practice location:
  • Phone: 616-776-3923
  • Fax: 616-776-3024
Mailing address:
  • Phone: 616-776-3923
  • Fax: 616-776-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301009848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: