Provider Demographics
NPI:1508103060
Name:KEMPKE, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KEMPKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GROVE ST
Mailing Address - Street 2:IRONMEN HEALTH CENTER
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-8018
Mailing Address - Country:US
Mailing Address - Phone:231-587-9840
Mailing Address - Fax:231-587-9846
Practice Address - Street 1:NELSON ELEMENTARY
Practice Address - Street 2:550 W GRAND AVENUE
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2336
Practice Address - Country:US
Practice Address - Phone:231-733-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012439101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508103060Medicaid