Healthcare Provider Details

I. General information

NPI: 1124642301
Provider Name (Legal Business Name): JESSICA GAYLE SZIKSZAY LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 E COLDWATER RD
FLINT MI
48505-1501
US

IV. Provider business mailing address

1057 E COLDWATER RD
FLINT MI
48505-1501
US

V. Phone/Fax

Practice location:
  • Phone: 810-424-6069
  • Fax:
Mailing address:
  • Phone: 810-424-6069
  • Fax: 810-257-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105659
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: