Individual
ANNE COLLEEN JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3100 WEST ROAD, EAST LANSING, MI 48823
(800) 379-1600
Mailing address
3100 WEST ROAD, EAST LANSING, MI 48823
(800) 379-1600
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801070186
MI
Other
Enumeration date
11/29/2018
Last updated
11/29/2018
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