Provider Demographics
NPI:1083183909
Name:JEPSON, BETH ELLYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ELLYN
Last Name:JEPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 ARBOR TRL NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7571
Mailing Address - Country:US
Mailing Address - Phone:616-774-9405
Mailing Address - Fax:
Practice Address - Street 1:1345 MONROE AVE NW STE 140
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4609
Practice Address - Country:US
Practice Address - Phone:616-458-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator