Provider Demographics
NPI:1518262294
Name:STUMP, JANICE CAROLE (MSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:CAROLE
Last Name:STUMP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:STUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2570 HOOSIER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7102
Mailing Address - Country:US
Mailing Address - Phone:231-499-4736
Mailing Address - Fax:
Practice Address - Street 1:2570 HOOSIER VALLEY RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-7102
Practice Address - Country:US
Practice Address - Phone:231-499-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801069841104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker