Healthcare Provider Details

I. General information

NPI: 1376591446
Provider Name (Legal Business Name): JODY NELSON RSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W LAKE LANSING RD STE A100
EAST LANSING MI
48823-8404
US

IV. Provider business mailing address

1092 SAINT JOHNS CHASE
GRAND LEDGE MI
48837-9781
US

V. Phone/Fax

Practice location:
  • Phone: 517-526-0036
  • Fax:
Mailing address:
  • Phone: 517-526-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801074609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: