Healthcare Provider Details

I. General information

NPI: 1710391347
Provider Name (Legal Business Name): JENNIFER LYNN AUSTIN LMSW-C, LISW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W CENTRE AVE STE 204
PORTAGE MI
49024-5393
US

IV. Provider business mailing address

1611 W CENTRE AVE STE 204
PORTAGE MI
49024-5393
US

V. Phone/Fax

Practice location:
  • Phone: 269-478-9529
  • Fax: 866-475-0053
Mailing address:
  • Phone: 269-478-9529
  • Fax: 866-475-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095097
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137020
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35886
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: