Provider Demographics
NPI:1821196262
Name:JONGSMA, ARTHUR EDWARD JR (PHD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:EDWARD
Last Name:JONGSMA
Suffix:JR
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 1:3351 CLAYSTONE SE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5781
Mailing Address - Country:US
Mailing Address - Phone:616-954-1992
Mailing Address - Fax:616-954-1998
Practice Address - Street 1:3351 CLAYSTONE SE
Practice Address - Street 2:SUITE 212
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5781
Practice Address - Country:US
Practice Address - Phone:616-954-1992
Practice Address - Fax:616-954-1998
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM35870006Medicare ID - Type Unspecified