Healthcare Provider Details

I. General information

NPI: 1255744413
Provider Name (Legal Business Name): JASMINE EMERICK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMINE MARTIN

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-5270
  • Fax: 616-455-5460
Mailing address:
  • Phone: 616-281-6372
  • Fax: 616-281-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: