Provider Demographics
NPI:1497808117
Name:STOCKINGER, JANE LYNNE (LMSW ACSW BSN RN)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LYNNE
Last Name:STOCKINGER
Suffix:
Gender:F
Credentials:LMSW ACSW BSN RN
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LYNNETTE
Other - Last Name:SEAR FOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2828 KRAFT AVE SE
Mailing Address - Street 2:SUITE 272
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2076
Mailing Address - Country:US
Mailing Address - Phone:616-940-9090
Mailing Address - Fax:616-940-9089
Practice Address - Street 1:2828 KRAFT AVE SE
Practice Address - Street 2:SUITE 272
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2076
Practice Address - Country:US
Practice Address - Phone:616-940-9090
Practice Address - Fax:616-940-9089
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010809521041C0700X
MI4704077527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF371463522001OtherSTATE VENDOR
8008944510OtherBCBS
P73035Medicare UPIN
MI0N8330Medicare ID - Type Unspecified