Active NPI
Jesi Nicole Sortwell, TLLP
- Psychologist
- Holland, MI
National Provider Identifier
1013794122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6362009820
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 6362009820 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Hope Project | Current | Accepting new patients | |
| Grand Rapids Therapy Group Inc | Psychologist | Past | 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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Muskegon, MI
- NPI 1801418405
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.