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NPI Code Detail

MEDICARE: MRS. CHERI JESSUP MSW

MEDICARE: MRS. CHERI JESSUP MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801088054MI

General Provider Information

NPI Number : 1184643777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHERI JESSUP MSW
Provider Business Mailing Address
First Line : 3111 ELECTRIC AVE
Second Line :
City : PORT HURON
State : MI
Zip : 48060-8127
Country : US
Telephone Number : 810-985-8900
Fax Number :
Provider Business Practice Location Address
First Line : 3111 ELECTRIC AVE
Second Line :
City : PORT HURON
State : MI
Zip : 48060-8127
Country : US
Telephone Number : 810-985-8900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 01/29/2009

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Directions to “ MRS. CHERI JESSUP MSW” Practice Location

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