Individual
KATHERINE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3351 CLAYSTONE ST SE STE G32, GRAND RAPIDS, MI 49546-5794
(616) 259-6827
Mailing address
2042 INNWOOD DR SE, KENTWOOD, MI 49508-5066
(616) 260-4597
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0019661
CO
101YP2500X
Professional Counselor
Primary
6401222851
MI
Other
Enumeration date
07/15/2019
Last updated
04/19/2024
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