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General NPI Number Information
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NPI Number | 1225693922
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Entity Type | Individual
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Provider Name | JESSIKA EVELYN DOYLE LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1699 N NINE MILE RD
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City | SANFORD
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State | MI
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Zip | 48657-9729
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Country | US
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Telephone | 989-284-1486
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Fax |
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Provider Business Mailing Address
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Address Line | 1699 N NINE MILE RD
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City | SANFORD
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State | MI
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Zip | 48657-9729
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Country | US
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Telephone | 989-284-1486
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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 | 6801096907
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW142162
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61634715
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License Number State | WA
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