Healthcare Provider Details

I. General information

NPI: 1326073198
Provider Name (Legal Business Name): DENISE JANE FARMER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W MICHIGAN AVE STE 802
JACKSON MI
49201
US

IV. Provider business mailing address

6975 EATON RAPIDS RD
ALBION MI
49224-9302
US

V. Phone/Fax

Practice location:
  • Phone: 517-888-3592
  • Fax: 855-421-1773
Mailing address:
  • Phone: 517-888-3592
  • Fax: 855-421-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086028
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: