Provider Demographics
NPI:1386995900
Name:JANE L. SPIES-WERT, PH.D., P.C.
Entity type:Organization
Organization Name:JANE L. SPIES-WERT, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPIES-WERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-965-1805
Mailing Address - Street 1:15 IONIA AVE SW
Mailing Address - Street 2:SUITE 645
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4102
Mailing Address - Country:US
Mailing Address - Phone:616-965-1805
Mailing Address - Fax:
Practice Address - Street 1:15 IONIA AVE SW
Practice Address - Street 2:SUITE 645
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4102
Practice Address - Country:US
Practice Address - Phone:616-965-1805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty