Individual
MITTANGE JACQUES-ESSEX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
1000 PARCHMENT DR SE, GRAND RAPIDS, MI 49546-3663
(616) 957-9112
(616) 957-2409
Mailing address
1000 PARCHMENT DR SE, GRAND RAPIDS, MI 49546-3663
(616) 957-9112
(616) 957-2409
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016210
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301016210
STATE PROFESSIONAL LICENSE
MI
Enumeration date
08/15/2018
Last updated
08/15/2018
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