Provider Demographics
NPI:1194227439
Name:HEINLEN, JANICE
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:HEINLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 PRAIRIE ST SW STE 104
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2076
Mailing Address - Country:US
Mailing Address - Phone:616-537-2872
Mailing Address - Fax:
Practice Address - Street 1:3181 PRAIRIE ST SW STE 104
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2076
Practice Address - Country:US
Practice Address - Phone:616-537-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014612101YP2500X
MI6401018844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional