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General NPI Number Information
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NPI Number | 1790322493
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Entity Type | Individual
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Provider Name | JENNIFER HAZEL-WORLEY LLMSW
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Gender | Female
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 4700 CANAL AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-9724
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Country | US
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Telephone | 616-439-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 4005 WOODLAND CREEK DR SE APT 102
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City | KENTWOOD
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State | MI
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Zip | 49512-8313
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Country | US
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Telephone | 810-543-0501
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801104528
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License Number State | MI
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