Provider Demographics
NPI:1881354041
Name:JEPKEMA, DUSTIN (LMSW)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:JEPKEMA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:DUSTY
Other - Middle Name:
Other - Last Name:JEPKEMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:618 E STOCKBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3836
Practice Address - Country:US
Practice Address - Phone:269-312-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011095441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical