Healthcare Provider Details

I. General information

NPI: 1710779848
Provider Name (Legal Business Name): MISS JESSICA MARIE HAVEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 EAGLE CREST DR NE STE 100
GRAND RAPIDS MI
49525-7005
US

IV. Provider business mailing address

7175 ROLLING OAKS LN
MIDDLEVILLE MI
49333-9196
US

V. Phone/Fax

Practice location:
  • Phone: 616-514-8673
  • Fax:
Mailing address:
  • Phone: 616-514-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: