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General NPI Number Information
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NPI Number | 1407077118
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Entity Type | Individual
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Provider Name | MRS. KARA JANEEN JAEKEL
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1470 PECK ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2158
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Country | US
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Telephone | 231-724-3300
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Fax | 231-724-3348
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Provider Business Mailing Address
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Address Line | 4750 DOWLING ST
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City | MONTAGUE
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State | MI
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Zip | 49437-1223
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Country | US
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Telephone | 231-893-5111
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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