Healthcare Provider Details

I. General information

NPI: 1679404560
Provider Name (Legal Business Name): JENNIFER AUSTIN LMSW MDIV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W CENTRE AVE
PORTAGE MI
49024-5344
US

IV. Provider business mailing address

1909 THRUSHWOOD AVE
PORTAGE MI
49002-5761
US

V. Phone/Fax

Practice location:
  • Phone: 269-330-5755
  • Fax:
Mailing address:
  • Phone: 269-330-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER LYNN AUSTIN
Title or Position: CLINICAL SOCIAL WORKER/THERAPIST
Credential: LMSW-C, LISW, LICSW
Phone: 269-478-9529