Healthcare Provider Details

I. General information

NPI: 1275440984
Provider Name (Legal Business Name): HEIDI MARIE JANSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PLASTICS PL
KALAMAZOO MI
49001-4882
US

IV. Provider business mailing address

1410 JOHNSTON ST SE
GRAND RAPIDS MI
49507-2828
US

V. Phone/Fax

Practice location:
  • Phone: 616-315-0988
  • Fax:
Mailing address:
  • Phone: 616-315-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2474040300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: