Basic Information
| Provider Information | |||||||||
| NPI: | 1447734520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAHNKE | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 3 MILE RD NW STE 101 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495448209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167858900 | ||||||||
| FaxNumber: | 6167858949 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 3 MILE RD NW STE 101 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495448209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167858900 | ||||||||
| FaxNumber: | 6167858949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2018 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401010077 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.