Provider Demographics
NPI:1538033154
Name:JUBECK, JENNALYN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:JENNALYN
Middle Name:MARIE
Last Name:JUBECK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 BAYBERRY FARMS DR SW APT 4
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9118
Mailing Address - Country:US
Mailing Address - Phone:517-993-8842
Mailing Address - Fax:
Practice Address - Street 1:2774 BIRCHCREST DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-5477
Practice Address - Country:US
Practice Address - Phone:616-988-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011196561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty