Healthcare Provider Details

I. General information

NPI: 1861680456
Provider Name (Legal Business Name): JENNIFER ROSE HUMPHREYS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/17/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28475 GREENFIELD RD STE 113
SOUTHFIELD MI
48076-3034
US

IV. Provider business mailing address

28475 SOUTHFIELD ROAD SUITE 113
SOUTHFIELD MI
48076-2468
US

V. Phone/Fax

Practice location:
  • Phone: 248-962-3329
  • Fax:
Mailing address:
  • Phone: 248-962-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: