Provider Demographics
NPI:1114536406
Name:STONE, JENNIFER AMY (MA, LLPCE)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:AMY
Last Name:STONE
Suffix:
Gender:F
Credentials:MA, LLPCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 HILLRISE CT NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9651
Mailing Address - Country:US
Mailing Address - Phone:616-690-6139
Mailing Address - Fax:
Practice Address - Street 1:4433 HILLRISE CT NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9651
Practice Address - Country:US
Practice Address - Phone:616-690-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional