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General NPI Number Information
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NPI Number | 1649851379
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Entity Type | Organization
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Legal Business Name | JANN LA DERE MSW LLC
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 6301 M 68 HWY
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City | INDIAN RIVER
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State | MI
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Zip | 49749-9366
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Country | US
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Telephone | 231-203-3231
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Fax | 231-238-5003
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Provider Business Mailing Address
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Address Line | 108 S HURON ST
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City | CHEBOYGAN
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State | MI
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Zip | 49721-1627
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Country | US
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Telephone | 231-203-3231
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Fax | 231-238-5003
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JANET MARIE LADERE
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Credential | LMSW
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Telephone | 231-203-3231
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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 |
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License Number State |
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