Provider Demographics
NPI:1619027844
Name:NEWMAN, JON STEFFEN (PHD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:STEFFEN
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 SEMINOLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6733
Mailing Address - Country:US
Mailing Address - Phone:231-780-0100
Mailing Address - Fax:231-780-0111
Practice Address - Street 1:837 SEMINOLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-6733
Practice Address - Country:US
Practice Address - Phone:231-780-0100
Practice Address - Fax:231-780-0111
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013149103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP23730002OtherWPS MEDICARE B
MI144318000OtherMAGELLAN
MI680F111610OtherBLUE CROSS
MI680F111610OtherBLUE CROSS
MI144318000OtherMAGELLAN