Healthcare Provider Details

I. General information

NPI: 1386359552
Provider Name (Legal Business Name): JENNIFER LYNN KOFFEMAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WASHINGTON AVE
JACKSON MI
49201-2180
US

IV. Provider business mailing address

341 ADDIE CT
MICHIGAN CENTER MI
49254-1301
US

V. Phone/Fax

Practice location:
  • Phone: 517-227-6038
  • Fax:
Mailing address:
  • Phone: 269-615-3827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851115992
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: