Provider Demographics
NPI:1053066696
Name:JUNGSLAGER, ERIN (EDS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:JUNGSLAGER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12685 RIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8688
Mailing Address - Country:US
Mailing Address - Phone:616-283-4185
Mailing Address - Fax:
Practice Address - Street 1:12685 RIVERTON RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8688
Practice Address - Country:US
Practice Address - Phone:616-283-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC-2C4840199191103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool