MEDICARE: JENNIFER ROBERTS

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
1	101YP2500X	Professional Counselor	6401014168	MI

General Provider Information

NPI Number	:	1518485853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROBERTS

Provider Business Mailing Address
First Line	:	901 EASTERN AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-1201
Country	:	US
Telephone Number	:	616-279-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 36TH ST SE STE 400
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-5581
Country	:	US
Telephone Number	:	616-965-8158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	02/18/2026

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Directions to “ JENNIFER ROBERTS ” Practice Location

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