Healthcare Provider Details

I. General information

NPI: 1508103060
Provider Name (Legal Business Name): JESSICA KEMPKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NELSON ELEMENTARY 550 W GRAND AVENUE
MUSKEGON MI
49441-2336
US

IV. Provider business mailing address

205 GROVE ST IRONMEN HEALTH CENTER
MANCELONA MI
49659-8018
US

V. Phone/Fax

Practice location:
  • Phone: 231-733-6680
  • Fax:
Mailing address:
  • Phone: 231-587-9840
  • Fax: 231-587-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: