Provider Demographics
NPI:1194266791
Name:FROMIUS, JENNIFER ROSE (MT-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:FROMIUS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1285
Mailing Address - Country:US
Mailing Address - Phone:714-609-0858
Mailing Address - Fax:
Practice Address - Street 1:1000 OLIVER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1285
Practice Address - Country:US
Practice Address - Phone:714-609-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0646647958-8OtherHEALTHCARE PROVIDERS SERVICE ORGANIZATION