Healthcare Provider Details

I. General information

NPI: 1063334670
Provider Name (Legal Business Name): LEA JADE LOUIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 BALDWIN ST
JENISON MI
49428-8937
US

IV. Provider business mailing address

6101 LAKE MICHIGAN DR APT B205
ALLENDALE MI
49401-9281
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-5014
  • Fax:
Mailing address:
  • Phone: 269-830-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: