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NPI Code Detail

MEDICARE: ASHLEY JANSMA LPC

MEDICARE:   ASHLEY  JANSMA  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor6401013093MI

General Provider Information

NPI Number : 1477944692
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY JANSMA LPC
Provider Business Mailing Address
First Line : 805 LEONARD ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-1138
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1444 MICHIGAN ST NE STE 7
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2028
Country : US
Telephone Number : 248-894-8421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2015
Last Update Date : 01/10/2020

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