Individual
GERALDINE MARIE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, ETS
Contact information
Practice address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 450-6482
Mailing address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 450-6482
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
000000
MI
174400000X
Specialist
—
—
Other
Enumeration date
12/29/2010
Last updated
08/23/2021
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