Healthcare Provider Details

I. General information

NPI: 1619880135
Provider Name (Legal Business Name): JESSICA ANNE HAUSER BRYDON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17001 FERRIS ST
GRAND HAVEN MI
49417-9441
US

IV. Provider business mailing address

17362 TIMBER DUNES DR
GRAND HAVEN MI
49417-8835
US

V. Phone/Fax

Practice location:
  • Phone: 616-850-6000
  • Fax:
Mailing address:
  • Phone: 630-890-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801110370
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801110370
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: