Individual
TERESA ANNE JEX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2932 PINE GROVE AVE, PORT HURON, MI 48060-8811
(810) 966-9191
(810) 679-0202
Mailing address
81 N HOWARD AVE, CROSWELL, MI 48422-1222
(810) 679-0200
(810) 679-0202
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13795639
CAQH
MI
01
—
21270
NCTRC
—
01
—
6803086827
SOCIAL SERVICE TECHNICIAN
MI
Enumeration date
03/16/2016
Last updated
05/09/2016
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