Provider Demographics
NPI:1164148789
Name:JENNIFER ANIBLE
Entity Type:Organization
Organization Name:JENNIFER ANIBLE
Other - Org Name:JENNIFER ANIBLE, LMSW, RPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, RPT
Authorized Official - Phone:616-551-6623
Mailing Address - Street 1:1334 LOGAN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2554
Mailing Address - Country:US
Mailing Address - Phone:616-551-6623
Mailing Address - Fax:
Practice Address - Street 1:1422 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2717
Practice Address - Country:US
Practice Address - Phone:616-551-6623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty