Healthcare Provider Details

I. General information

NPI: 1255243861
Provider Name (Legal Business Name): AIMEE JACKSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE BOSCH LMSW

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 CHIPPEWA ST
JENISON MI
49428-9116
US

IV. Provider business mailing address

3181 DEER HAVEN DR
JENISON MI
49428-8555
US

V. Phone/Fax

Practice location:
  • Phone: 616-457-1407
  • Fax:
Mailing address:
  • Phone: 616-540-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number681095565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: