Individual provider Active NPI

Jesi Nicole Sortwell, TLLP

  • Psychologist
  • Holland, MI
National Provider Identifier
1013794122
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6362009820 Issued in MI
Practice address
238 Hoover Blvd Ste 10
Holland, MI 49423-3755
Phone
(616) 591-9000
NPI assigned
Sep 12, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6362009820 MI Primary

Addresses

Primary practice location

238 Hoover Blvd Ste 10
Holland, MI 49423-3755

Mailing address

2699 Kennedy CT
Hudsonville, MI 49426-1814
Phone (616) 320-2010

Other practice location 1

1516 Peck St
Muskegon, MI 49441-2128
Phone (231) 747-8555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6362009820MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Hope Project CurrentSince Sep 1, 2023 Accepting new patients
Grand Rapids Therapy Group Inc Psychologist PastSince Mar 31, 2024 Accepting new patients

Locations

1516 Peck St
Muskegon, MI 49441
Phone (231) 335-0952

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1013794122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2699 KENNEDY CT",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494261814",
            "telephone_number": "616-320-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 HOOVER BLVD STE 10",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494233755",
            "telephone_number": "616-591-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1516 Peck St",
            "address_purpose": "LOCATION",
            "city": "Muskegon",
            "state": "MI",
            "postal_code": "494412128",
            "country_code": "US",
            "telephone_number": "231-747-8555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SORTWELL",
        "first_name": "JESI",
        "middle_name": "NICOLE",
        "credential": "TLLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-12",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6362009820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.