Healthcare Provider Details

I. General information

NPI: 1699328559
Provider Name (Legal Business Name): JESSICA BARANOWSKI LMSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 WASHINGTON AVE
BAY CITY MI
48708-5705
US

IV. Provider business mailing address

1009 WASHINGTON AVE
BAY CITY MI
48708-5705
US

V. Phone/Fax

Practice location:
  • Phone: 989-928-3566
  • Fax: 989-391-9596
Mailing address:
  • Phone: 989-928-3566
  • Fax: 989-391-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: