Provider Demographics
NPI:1184172496
Name:PIEHL, JESSE J (PHD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:J
Last Name:PIEHL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:3292 EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9580
Mailing Address - Country:US
Mailing Address - Phone:616-365-8920
Mailing Address - Fax:616-365-8971
Practice Address - Street 1:3292 EVERGREEN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9580
Practice Address - Country:US
Practice Address - Phone:616-365-8920
Practice Address - Fax:616-365-8971
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301016429103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist