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General NPI Number Information
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NPI Number | 1093247702
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Entity Type | Individual
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Provider Name | JACQUELINE LEE KONLEY LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 10315 GRAND RIVER RD STE 302
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City | BRIGHTON
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State | MI
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Zip | 48116-9586
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Country | US
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Telephone | 734-657-8059
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Fax |
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Provider Business Mailing Address
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Address Line | 3794 CORDLEY LAKE RD
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City | PINCKNEY
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State | MI
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Zip | 48169-8443
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Country | US
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Telephone | 517-404-9834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801095263
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License Number State | MI
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