Provider Demographics
NPI:1407103047
Name:JONGEKRYG, SUSAN F (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:JONGEKRYG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SZEBELLEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6945 BELDING RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8212
Mailing Address - Country:US
Mailing Address - Phone:616-329-3642
Mailing Address - Fax:
Practice Address - Street 1:680 3 MILE RD NW
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8218
Practice Address - Country:US
Practice Address - Phone:616-647-3460
Practice Address - Fax:616-647-3467
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010947371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical