Healthcare Provider Details

I. General information

NPI: 1669740767
Provider Name (Legal Business Name): JANETTE D CURTIS LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 BALDWIN ST
JENISON MI
49428-8901
US

IV. Provider business mailing address

1836 BALDWIN ST
JENISON MI
49428-8901
US

V. Phone/Fax

Practice location:
  • Phone: 616-457-0016
  • Fax: 616-457-1950
Mailing address:
  • Phone: 616-457-0016
  • Fax: 616-457-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301014917
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014917
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: