Healthcare Provider Details

I. General information

NPI: 1609591833
Provider Name (Legal Business Name): JILL MAGRUM MA, CAADC-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 E MITCHELL RD
PETOSKEY MI
49770-9604
US

IV. Provider business mailing address

2236 E MITCHELL RD
PETOSKEY MI
49770-9604
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-9880
  • Fax: 231-347-9313
Mailing address:
  • Phone: 231-347-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: