Healthcare Provider Details

I. General information

NPI: 1538033154
Provider Name (Legal Business Name): JENNALYN MARIE JUBECK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2774 BIRCHCREST DR SE
GRAND RAPIDS MI
49506-5477
US

IV. Provider business mailing address

5850 BAYBERRY FARMS DR SW APT 4
WYOMING MI
49418-9118
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-3422
  • Fax:
Mailing address:
  • Phone: 517-993-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: