| Doctor Name: | MRS. JANE MUDROVICH KIDDER |
| NPI Number: | 1053527051 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 6401001669 |
| Business Practice Address: | 1100 Ludington St Suite 305 Escanaba, MI - 498293542 |
| Business Phone Number: | 9062331404 |
| Business Fax Number: | |
| Mailing Address: | N8349 Dragic Rd, STEPHENSON |
| State: | MI |
| Postal Code: | 49887 |
| Phone Number: | 9062331404 |
| Fax Number: | |
| NPI Enumeration Date: | 05/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401001669 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |