Provider Demographics
NPI:1902517246
Name:FEUTZ, JAMMIE LEIGH (LLMSW)
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:LEIGH
Last Name:FEUTZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 PEREGRINE DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9723
Mailing Address - Country:US
Mailing Address - Phone:616-643-0833
Mailing Address - Fax:616-643-0844
Practice Address - Street 1:3152 PEREGRINE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9723
Practice Address - Country:US
Practice Address - Phone:616-643-0833
Practice Address - Fax:616-643-0844
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511146991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical