Jessica Amber Bazan Deraedt, LMSW
Social Worker, Clinical in Jackson, MI. Individual provider (NPI-1).
NPI number1083170963
StatusActive
Last updated in NPPESJul 17, 2020
Details
- NPI
- 1083170963
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Jessica Amber Bazan Deraedt
- Credential
- LMSW
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 15, 2019
- Certification date
- Jul 17, 2020
- Last updated
- Jul 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 6801101750 | MI | Yes |
Practice location
1108 Homewild AveJackson, MI 49201-1835
Phone 231-679-0648
Mailing address
1108 Homewild AveJackson, MI 49201-1835
Phone 231-679-0648
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