Healthcare Provider Details

I. General information

NPI: 1356863484
Provider Name (Legal Business Name): JUANITA KAY MEYERINK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

12901 E MICHIGAN AVE
GRASS LAKE MI
49240-9283
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-5500
  • Fax: 517-783-2728
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801100819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: