Provider Demographics
NPI:1760134407
Name:PRINCE, JEANETTE (MSW)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 ARROYO VISTA DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9474
Mailing Address - Country:US
Mailing Address - Phone:616-818-9082
Mailing Address - Fax:
Practice Address - Street 1:3600 CAMELOT DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8103
Practice Address - Country:US
Practice Address - Phone:616-949-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator