Provider Demographics
NPI:1649767286
Name:BRUNDIGE, JENNIFER ROCHELLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROCHELLE
Last Name:BRUNDIGE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 W SAGINAW HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2654
Mailing Address - Country:US
Mailing Address - Phone:989-272-3203
Mailing Address - Fax:
Practice Address - Street 1:4710 W SAGINAW HWY STE 1
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2654
Practice Address - Country:US
Practice Address - Phone:989-272-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009390101Y00000X
MI6401222275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor