Provider Demographics
NPI:1053796185
Name:JELTEMA, ERIN (MA, CADC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:JELTEMA
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1638
Mailing Address - Country:US
Mailing Address - Phone:616-522-0687
Mailing Address - Fax:
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1638
Practice Address - Country:US
Practice Address - Phone:616-522-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015636101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)