Healthcare Provider Details

I. General information

NPI: 1144678210
Provider Name (Legal Business Name): JACLYN MICHELLE ABBATE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E BELTLINE AVE NE STE 204
GRAND RAPIDS MI
49525-4598
US

IV. Provider business mailing address

1525 E BELTLINE AVE NE STE 204
GRAND RAPIDS MI
49525-4598
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-1200
  • Fax: 616-288-9045
Mailing address:
  • Phone: 616-965-1200
  • Fax: 616-288-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: