Provider Demographics
NPI:1598880973
Name:BOEDECKER, JANE ANN (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANN
Last Name:BOEDECKER
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 COLUMBIA AVE E
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4463
Mailing Address - Country:US
Mailing Address - Phone:269-963-7135
Mailing Address - Fax:269-963-0071
Practice Address - Street 1:497 COLUMBIA AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4463
Practice Address - Country:US
Practice Address - Phone:269-963-7135
Practice Address - Fax:269-963-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011747103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling