Healthcare Provider Details

I. General information

NPI: 1477435972
Provider Name (Legal Business Name): ANNIKA JAROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 SEMINOLE RD STE 200B
NORTON SHORES MI
49444-3747
US

IV. Provider business mailing address

2055 BLUEBERRY DR NW
GRAND RAPIDS MI
49504-2504
US

V. Phone/Fax

Practice location:
  • Phone: 231-777-2222
  • Fax:
Mailing address:
  • Phone: 616-916-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: