Provider Demographics
NPI:1619545399
Name:ARBOGAST, JENNIFER LEE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:ARBOGAST
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 1:300 BAILEY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4688
Mailing Address - Country:US
Mailing Address - Phone:517-273-2706
Mailing Address - Fax:517-798-5677
Practice Address - Street 1:300 BAILEY ST STE 2
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4688
Practice Address - Country:US
Practice Address - Phone:517-273-2706
Practice Address - Fax:517-798-5677
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011100701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical