Healthcare Provider Details

I. General information

NPI: 1376450858
Provider Name (Legal Business Name): JESSICA MARIE JAQUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8032 S MISSION RD
MOUNT PLEASANT MI
48858-8167
US

IV. Provider business mailing address

8032 S MISSION RD
MOUNT PLEASANT MI
48858-8167
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-4840
  • Fax:
Mailing address:
  • Phone: 616-202-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: