Provider Demographics
NPI:1932606019
Name:DIGENNARO, JENNIFER KARLEEN (LLPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KARLEEN
Last Name:DIGENNARO
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KARLEEN
Other - Last Name:ROSEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3501 TUSCANY DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7247
Mailing Address - Country:US
Mailing Address - Phone:616-446-6728
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKE DR SE STE 8
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1673
Practice Address - Country:US
Practice Address - Phone:616-446-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional