Provider Demographics
NPI:1417592551
Name:WHITE, JANE ELLEN (HIS)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ELLEN
Other - Last Name:LEHNERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 3 MILE RD NW OFC D
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1650
Mailing Address - Country:US
Mailing Address - Phone:616-538-5300
Mailing Address - Fax:616-538-5006
Practice Address - Street 1:4635 14 MILE RD NE STE A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7310
Practice Address - Country:US
Practice Address - Phone:616-884-5877
Practice Address - Fax:616-884-5879
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501010458237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist