Healthcare Provider Details

I. General information

NPI: 1245617455
Provider Name (Legal Business Name): JACQUELINE REINE NEWSOME LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3496 E LAKE LANSING RD STE 100
EAST LANSING MI
48823-6222
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 989-323-7916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098297
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: