MEDICARE: MRS. AMY LYNN JEHNZEN LMSW

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	101Y00000X	Counselor	6801087919	MI

General Provider Information

NPI Number	:	1588991756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LYNN JEHNZEN LMSW

Provider Business Mailing Address
First Line	:	1715 LANSING AVE STE 672
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2193
Country	:	US
Telephone Number	:	517-788-4364
Fax Number	:	517-780-4739

Provider Business Practice Location Address
First Line	:	1715 LANSING AVE STE 672
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2193
Country	:	US
Telephone Number	:	517-788-4364
Fax Number	:	517-780-4739

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

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	11/10/2009

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