Healthcare Provider Details

I. General information

NPI: 1730119744
Provider Name (Legal Business Name): JEFFREY W MAPLES MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

505 N JACKSON ST
JACKSON MI
49201-1266
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801078096
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: