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General NPI Number Information
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NPI Number | 1700552304
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Entity Type | Individual
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Provider Name | JAMIE LYNN PLOURDE
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 5051 MCCARTY RD
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City | SAGINAW
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State | MI
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Zip | 48603-9620
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Country | US
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Telephone | 800-438-1772
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Fax | 262-345-5562
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR
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City | GERMANTOWN
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State | WI
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Zip | 53022-4799
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Country | US
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Telephone | 800-438-1772
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Fax | 262-345-5562
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851108469
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License Number State | MI
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