Provider Demographics
NPI:1912647116
Name:FASSBENDER, JENNA (BS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FASSBENDER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 40TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4407
Mailing Address - Country:US
Mailing Address - Phone:616-856-6864
Mailing Address - Fax:
Practice Address - Street 1:1111 40TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4407
Practice Address - Country:US
Practice Address - Phone:616-856-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker