Healthcare Provider Details

I. General information

NPI: 1215375761
Provider Name (Legal Business Name): JENNA E HULL LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S LAPEER RD
OXFORD MI
48371-6108
US

IV. Provider business mailing address

1450 S LAPEER RD
OXFORD MI
48371-6108
US

V. Phone/Fax

Practice location:
  • Phone: 248-969-9932
  • Fax:
Mailing address:
  • Phone: 248-969-9932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802086869
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: