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General NPI Number Information
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NPI Number | 1124647805
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Entity Type | Individual
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Provider Name | JARED HOST
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Gender | Male
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | MERCY HEALTH HAUENSTEIN NEUROSCIENCE CENTER 220 CHERRY
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-685-6746
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Fax |
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Provider Business Mailing Address
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Address Line | HAUENSTEIN NEUROSCIENCE CENTER 220 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-685-6749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101004610
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License Number State | MI
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