Healthcare Provider Details

I. General information

NPI: 1164035143
Provider Name (Legal Business Name): JALYN ELIZABETH AUNE BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JALYN ELIZABETH STUART

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 NORTHLAND DR NE STE B
GRAND RAPIDS MI
49525-1073
US

IV. Provider business mailing address

14440 BAILEY RD
BAILEY MI
49303-9734
US

V. Phone/Fax

Practice location:
  • Phone: 616-344-4785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801118146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: