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NPI Code Detail

MEDICARE: AMY LYNN JARCHOW PHD

MEDICARE: AMY LYNN JARCHOW PHD
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
1103TC0700XClinical Psychologist6301013622MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11003859984OTHERTYPE 2 NPI

General Provider Information

NPI Number : 1952480915
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LYNN JARCHOW PHD
Provider Business Mailing Address
First Line : 3940 PENINSULAR DR SE STE 230
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-6187
Country : US
Telephone Number : 616-458-0692
Fax Number : 616-458-8129
Provider Business Practice Location Address
First Line : 2851 CHARLEVOIX DR SE STE 323
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-7092
Country : US
Telephone Number : 616-458-0692
Fax Number : 616-458-8129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 01/02/2025

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Directions to “ AMY LYNN JARCHOW PHD” Practice Location

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