Healthcare Provider Details

I. General information

NPI: 1588055305
Provider Name (Legal Business Name): JENNIFER A JENSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BROTHERS

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 EAST BELTLINE AVE SUITE 100
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

2235 WATERTOWN WAY
GRAND RAPIDS MI
49505-6049
US

V. Phone/Fax

Practice location:
  • Phone: 810-348-8793
  • Fax:
Mailing address:
  • Phone: 810-348-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: