Provider Demographics
NPI:1417134453
Name:BAZNER, JENNIFER (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BAZNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 WINCHELL ST SE APT SUITE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3227
Mailing Address - Country:US
Mailing Address - Phone:616-446-1117
Mailing Address - Fax:616-741-1706
Practice Address - Street 1:706 WINCHELL ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3227
Practice Address - Country:US
Practice Address - Phone:616-446-1117
Practice Address - Fax:616-741-1706
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009854101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor