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General NPI Number Information
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NPI Number | 1710457858
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Entity Type | Individual
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Provider Name | JASON DOUGLAS SIKKEMA MA MLP
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Gender | Male
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Dates
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Enumeration Date | 12/02/2018
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 1009 44TH ST SW STE 103
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City | WYOMING
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State | MI
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Zip | 49509-4480
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Country | US
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Telephone | 269-459-1818
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Fax | 269-365-9951
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Provider Business Mailing Address
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Address Line | 1009 44TH ST SW STE 103
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City | WYOMING
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State | MI
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Zip | 49509-4480
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Country | US
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Telephone | 616-322-4575
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6361005740
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License Number State | MI
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