Provider Demographics
NPI:1447734520
Name:JAHNKE, STEVEN (LPC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:JAHNKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 3 MILE RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8209
Mailing Address - Country:US
Mailing Address - Phone:616-785-8900
Mailing Address - Fax:616-785-8949
Practice Address - Street 1:640 3 MILE RD NW STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8209
Practice Address - Country:US
Practice Address - Phone:616-785-8900
Practice Address - Fax:616-785-8949
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional