Provider Demographics
NPI:1386847739
Name:HIGGINS, JANE CAROLINE (MA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:CAROLINE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 WHIPPOORWILL DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4534
Mailing Address - Country:US
Mailing Address - Phone:269-353-8286
Mailing Address - Fax:
Practice Address - Street 1:4328 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5823
Practice Address - Country:US
Practice Address - Phone:269-375-2222
Practice Address - Fax:269-375-8292
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013547103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist