Individual
JENNIFER JEANNE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
7745 JONAGOLD DR SE, GRAND RAPIDS, MI 49508-7602
(616) 970-4636
Mailing address
7745 JONAGOLD DR SE, GRAND RAPIDS, MI 49508-7602
(800) 435-2197
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401013557
MI
Other
Enumeration date
07/29/2010
Last updated
11/15/2013
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