Individual
THEODORE J JANSMA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3330 CLAYSTONE ST SE, GRAND RAPIDS, MI 49546-7716
(616) 942-8060
(616) 942-6690
Mailing address
PO BOX 30516, DEPT 6065, LANSING, MI 48909-8016
(616) 532-8000
(616) 532-7230
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301001233
MI
Other
Enumeration date
12/29/2005
Last updated
06/26/2008
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