Healthcare Provider Details

I. General information

NPI: 1477265486
Provider Name (Legal Business Name): JENIFER GOKCE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DIANA ST
LUDINGTON MI
49431-1987
US

IV. Provider business mailing address

920 DIANA ST
LUDINGTON MI
49431-1987
US

V. Phone/Fax

Practice location:
  • Phone: 231-845-6294
  • Fax:
Mailing address:
  • Phone: 231-845-6294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: