Healthcare Provider Details

I. General information

NPI: 1528844271
Provider Name (Legal Business Name): JESSICA BEATTIE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E
GRAND RAPIDS MI
49503-3200
US

IV. Provider business mailing address

313 N DIANE CT
STANDISH MI
48658-9702
US

V. Phone/Fax

Practice location:
  • Phone: 346-861-6490
  • Fax:
Mailing address:
  • Phone: 517-614-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116717
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851116717
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: