Individual
JILL AGENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3809 LAKE EASTBROOK BLVD SE, GRAND RAPIDS, MI 49546-5931
(616) 604-8493
(616) 604-8493
Mailing address
3809 LAKE EASTBROOK BLVD SE, GRAND RAPIDS, MI 49546-5931
(616) 604-8492
(616) 604-8492
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/02/2022
Last updated
06/24/2025
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