Healthcare Provider Details

I. General information

NPI: 1598811614
Provider Name (Legal Business Name): JENNIFER LITZENBERG MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26755 BALLARD ST
HARRISON TOWNSHIP MI
48045-2419
US

IV. Provider business mailing address

35418 TIMBERWOOD CT
CLINTON TWP MI
48035-2158
US

V. Phone/Fax

Practice location:
  • Phone: 586-466-5234
  • Fax: 586-466-5397
Mailing address:
  • Phone: 260-410-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: