Healthcare Provider Details

I. General information

NPI: 1376195909
Provider Name (Legal Business Name): JENNIFER CORIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 WOODMEADOW DR SE
GRAND RAPIDS MI
49546-8031
US

IV. Provider business mailing address

2135 WOODBURN DR SE APT 11
GRAND RAPIDS MI
49546-4385
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-0194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114386
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: