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Individual

JENISE MAE EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BSW

Contact information

Practice address
10182 FOREST RD, GLADWIN, MI 48624-8811
(989) 429-4770
Mailing address
10182 FOREST RD, GLADWIN, MI 48624-8811
(989) 429-4770

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802086547
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6802086547
MI
Enumeration date
06/25/2013
Last updated
06/25/2013
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