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General NPI Number Information
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NPI Number | 1477010791
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Entity Type | Individual
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Provider Name | JESSICA CHESTER LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 2833 CROOKS RD
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City | TROY
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State | MI
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Zip | 48084-4732
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Country | US
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Telephone | 313-350-2159
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Fax |
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Provider Business Mailing Address
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Address Line | 8524 CASCADE ST
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-4707
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Country | US
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Telephone | 313-350-2159
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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 | 6801103856
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License Number State | MI
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