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Individual
JACALYN SUE LASICH
Active
Individual
JACALYN SUE LASICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801089753
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487909396
—
MI
01
—
6801089753
MICHIGAN LICENSE
MI
Enumeration date
07/17/2012
Last updated
07/21/2022
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