Jackie Lynn Jellison in Edwardsburg - Clinical
Jackie Lynn Jellison - NPI 1851595961
Jackie Lynn Jellison is a Clinical in Edwardsburg, Michigan. Jackie Lynn Jellison practices all healthcare services and medical treatments related to Clinical. The NPI Number for Jackie Lynn Jellison is 1851595961. The last update date is 2007-07-08.
Jackie Lynn Jellison's current location address is 69121 Gateway Dr Apt B1, Edwardsburg, Michigan. You can contact this provider via phone number 5748550770. The mailing address for Jackie Lynn Jellison is 69121 Gateway Dr Apt B1, Edwardsburg, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jackie Lynn Jellison |
|---|---|
| Address | 69121 Gateway Dr Apt B1, Edwardsburg, Michigan |
| Phone Number | 5748550770 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | LCSW |
NPI Number Detail
| NPI Number | 1851595961 |
|---|---|
| Provider Enumeration Date | 2007-06-13 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 69121 Gateway Dr Apt B1 |
|---|---|
| City | Edwardsburg |
| State | Michigan (MI) |
| Post Code | 491128209 |
| Phone Number | 5748550770 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | 34005297A |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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What is the unique provider identifier assigned to Jackie Lynn Jellison?
The Jackie Lynn Jellison has been issued the NPI (National Provider Identifier) 1851595961 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Could you please provide the complete physical location address of Jackie Lynn Jellison?
The Jackie Lynn Jellison is physically situated at 69121 Gateway Dr Apt B1, in the city of Edwardsburg, state of MI, with the postal code 491128209.
What is Jackie Lynn Jellison's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?
The area of specialization for Jackie Lynn Jellison is Clinical, and the taxonomy code that classifies this field of practice is 1041C0700X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1851595961 to Jackie Lynn Jellison?
The Centers for Medicare & Medicaid Services originally issued the 1851595961 to Jackie Lynn Jellison on 2007-06-13.
When was the information regarding Jackie Lynn Jellison most recently updated?
The details pertaining to the Jackie Lynn Jellison, including its address, specialty, and other relevant information, were last refreshed on 2007-07-08.
NPI Number: 1215930573
Address: 209 W Criser Rd, Front Royal, VA