Healthcare Provider Details

I. General information

NPI: 1003924853
Provider Name (Legal Business Name): JENNIFER LEE BRAMLETT SOCIAL SERVICES TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S PARKER ST SUITE D
MARINE CITY MI
48039-3572
US

IV. Provider business mailing address

6057 URBAN DR
EAST CHINA MI
48054-4750
US

V. Phone/Fax

Practice location:
  • Phone: 810-765-5010
  • Fax: 810-765-8451
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number6803080829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: