Healthcare Provider Details

I. General information

NPI: 1013757814
Provider Name (Legal Business Name): JENNIFER LYNN ERICKSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

135 E M35
GWINN MI
49841-9160
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1060
  • Fax: 906-372-3230
Mailing address:
  • Phone: 906-483-1130
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: