1184961831 NPI number — MRS. JESSICA JOY WHETSTONE LBSW

Table of content: MRS. JESSICA JOY WHETSTONE LBSW (NPI 1184961831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184961831 NPI number — MRS. JESSICA JOY WHETSTONE LBSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHETSTONE
Provider First Name:
JESSICA
Provider Middle Name:
JOY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LBSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184961831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10065 23 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49665-8023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-825-2257
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 COBB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CADILLAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49601-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-775-3463
Provider Business Practice Location Address Fax Number:
231-775-1692
Provider Enumeration Date:
01/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6802085153 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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