Healthcare Provider Details

I. General information

NPI: 1598114134
Provider Name (Legal Business Name): JASMYNE MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17421 TELEGRAPH RD
DETROIT MI
48219-3165
US

IV. Provider business mailing address

3870 LOVETT
DETROIT MI
48210
US

V. Phone/Fax

Practice location:
  • Phone: 313-255-0900
  • Fax:
Mailing address:
  • Phone: 313-802-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: