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NPI Code Detail

MEDICARE: JODI LYNN VISSER LMSW

MEDICARE: JODI LYNN VISSER LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator6801068843MI
21041C0700XClinical Social Worker6801068843MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1JT068843OTHERMIBCBS OF MICHIGAN

General Provider Information

NPI Number : 1124052535
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODI LYNN VISSER LMSW
Provider Business Mailing Address
First Line : 2222 W GRAND RIVER AVE STE A
Second Line :
City : OKEMOS
State : MI
Zip : 48864-1604
Country : US
Telephone Number : 616-229-4843
Fax Number :
Provider Business Practice Location Address
First Line : 2222 W GRAND RIVER AVE STE A
Second Line :
City : OKEMOS
State : MI
Zip : 48864-1604
Country : US
Telephone Number : 616-229-4843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 05/12/2025

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Directions to “ JODI LYNN VISSER LMSW” Practice Location

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