Healthcare Provider Details

I. General information

NPI: 1588069280
Provider Name (Legal Business Name): JESSIE LYNN KORTE LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25655 24 MILE RD
CHESTERFIELD MI
48051-1527
US

IV. Provider business mailing address

25655 24 MILE RD
CHESTERFIELD MI
48051-1527
US

V. Phone/Fax

Practice location:
  • Phone: 586-371-2455
  • Fax: 586-371-2455
Mailing address:
  • Phone: 586-371-2455
  • Fax: 586-371-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: