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General NPI Number Information
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NPI Number | 1922908698
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Entity Type | Individual
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Provider Name | JAIME LEE LAISURE LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 39465 W 14 MILE RD
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City | NOVI
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State | MI
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Zip | 48377-1600
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Country | US
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Telephone | 248-859-3900
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Fax | 888-483-0118
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Provider Business Mailing Address
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Address Line | 3409 BRONSON BLVD
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City | KALAMAZOO
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State | MI
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Zip | 49008-2975
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Country | US
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Telephone | 269-365-3643
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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 | 6801121101
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License Number State | MI
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