Healthcare Provider Details

I. General information

NPI: 1750899886
Provider Name (Legal Business Name): JESSICA HARDY LMSW, MHP, CMHP, QM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 TAYLOR DR
FLINT MI
48507-4665
US

IV. Provider business mailing address

PO BOX 289
MASON MI
48854-0289
US

V. Phone/Fax

Practice location:
  • Phone: 810-237-0799
  • Fax:
Mailing address:
  • Phone: 517-676-5405
  • Fax: 517-676-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114124
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6801100812
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: