Healthcare Provider Details

I. General information

NPI: 1982096087
Provider Name (Legal Business Name): JORDANA SEEBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 S. DIVISION SE
GRAND RAPIDS MI
49507
US

IV. Provider business mailing address

2332 EVEREST AVE SE
GRAND RAPIDS MI
49507-3061
US

V. Phone/Fax

Practice location:
  • Phone: 616-581-1936
  • Fax:
Mailing address:
  • Phone: 616-514-9735
  • 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: