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General NPI Number Information
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NPI Number | 1255903480
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Entity Type | Individual
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Provider Name | JAMI ROACH ELZINGA
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Gender | Female
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | 100 MICHIGAN ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone | 616-352-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 9395 SUNSET RIDGE DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7122
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Country | US
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Telephone | 989-640-3867
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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 | 7101003442
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License Number State | MI
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