Healthcare Provider Details

I. General information

NPI: 1205321668
Provider Name (Legal Business Name): JENNIFER DAWN CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4893 E BELTLINE AVE NE STE 310
GRAND RAPIDS MI
49525-9787
US

IV. Provider business mailing address

1465 SIBLEY ST
LOWELL MI
49331-1525
US

V. Phone/Fax

Practice location:
  • Phone: 616-279-6414
  • Fax:
Mailing address:
  • Phone: 616-430-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: