Active NPI
Jennifer Petersen, LLMSW
- Clinical Social Worker
- Grand Rapids, MI
National Provider Identifier
1386427136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6851109934
- Practice address
- 1331 Martin Luther King Jr St SE
Grand Rapids, MI 49506-2634 - Phone
- (616) 819-1067
- NPI assigned
- Aug 16, 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6851109934 | MI | Primary |
Addresses
Primary practice location
1331 Martin Luther King Jr St SE
Grand Rapids, MI 49506-2634
Mailing address
1331 Martin Luther King Jr St SE
Grand Rapids, MI 49506-2634
Phone (616) 819-1067
Other practice location 1
1331 Martin Luther King Jr St SE
Grand Rapids, MI 49506-2634
Phone (616) 819-1067
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 |
|---|---|---|---|
| 6851109934 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692144000000",
"number": "1386427136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1331 MARTIN LUTHER KING JR ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495062634",
"telephone_number": "616-819-1067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1331 MARTIN LUTHER KING JR ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495062634",
"telephone_number": "616-819-1067"
}
],
"practiceLocations": [
{
"address_1": "1331 Martin Luther King Jr St SE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495062634",
"country_code": "US",
"telephone_number": "616-819-1067",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSEN",
"first_name": "JENNIFER",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-16",
"last_updated": "2023-08-16",
"certification_date": "2023-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6851109934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.