Healthcare Provider Details

I. General information

NPI: 1477106763
Provider Name (Legal Business Name): JEFFREY FLEMING MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 BELLE CHASE WAY
LANSING MI
48911-4252
US

IV. Provider business mailing address

1440 SHERWOOD AVE
EAST LANSING MI
48823-1852
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3732
Mailing address:
  • Phone: 517-337-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801113561
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: