Individual
JACQUELYNN S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W.
Contact information
Practice address
10635 OCEAN BEACH RD, CLARKLAKE, MI 49234-9010
(517) 416-9186
Mailing address
10635 OCEAN BEACH RD, CLARKLAKE, MI 49234-9010
(517) 529-4928
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801057927
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801057927
MASTER'S SOCIAL WORKER CLINICAL AND MACRO LICENSE
MI
Enumeration date
06/26/2010
Last updated
06/26/2010
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