Healthcare Provider Details

I. General information

NPI: 1184437071
Provider Name (Legal Business Name): ARIANNA JEPSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W WACKERLY ST
MIDLAND MI
48640-2791
US

IV. Provider business mailing address

1519 MANOR LN
MT PLEASANT MI
48858-6004
US

V. Phone/Fax

Practice location:
  • Phone: 989-486-3021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352000929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: