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General NPI Number Information
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NPI Number | 1699447102
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Entity Type | Individual
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Provider Name | JADE ELIZABETH FREDERICK LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/03/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 22900 FEDERAL AVENUE HENRY FORD HEALTH SYSTEM CLINIC
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City | WARREN
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State | MI
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Zip | 48089
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Country | US
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Telephone | 248-266-0475
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Fax |
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Provider Business Mailing Address
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Address Line | 1269 WOODFIELD STREET
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City | LAKE ORION
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State | MI
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Zip | 48362
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Country | US
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Telephone |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801095095
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License Number State | MI
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