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General NPI Number Information
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NPI Number | 1538033154
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Entity Type | Individual
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Provider Name | JENNALYN MARIE JUBECK LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 2774 BIRCHCREST DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-5477
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Country | US
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Telephone | 616-988-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 BAYBERRY FARMS DR SW APT 4
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City | WYOMING
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State | MI
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Zip | 49418-9118
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Country | US
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Telephone | 517-993-8842
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801119656
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License Number State | MI
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