Active NPI
Jill M. Stephan-Bolduc, M.A.
- Professional Counselor
- Flint, MI
National Provider Identifier
1295882546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401004595
- Practice address
- 420 W 5TH Ave
Room 333
Flint, MI 48503-2445 - Phone
- (810) 496-5520
- Fax
- (810) 257-3775
- NPI assigned
- Jan 5, 2007
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401004595 | MI | Primary |
Addresses
Primary practice location
420 W 5TH Ave
Room 333
Flint, MI 48503-2445
Mailing address
2522 Bagley St
Flint, MI 48504-7702
Phone (810) 239-0047
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401004595 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295882546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2522 BAGLEY ST",
"city": "FLINT",
"state": "MI",
"postal_code": "485047702",
"telephone_number": "810-239-0047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W 5TH AVE",
"address_2": "ROOM 333",
"city": "FLINT",
"state": "MI",
"postal_code": "485032445",
"telephone_number": "810-496-5520",
"fax_number": "810-257-3775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHAN-BOLDUC",
"first_name": "JILL",
"middle_name": "M.",
"name_prefix": "Mrs.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401004595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.