Provider Demographics
NPI:1952480915
Name:JARCHOW, AMY LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:JARCHOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 PENINSULAR DR SE STE 230
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6187
Mailing Address - Country:US
Mailing Address - Phone:616-458-0692
Mailing Address - Fax:616-458-8129
Practice Address - Street 1:3940 PENINSULAR DR SE STE 230
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6187
Practice Address - Country:US
Practice Address - Phone:616-458-0692
Practice Address - Fax:616-458-8129
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202285103T00000X
MI6301013622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003859984OtherTYPE 2 NPI