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NPI Code Detail

MEDICARE: DEBRA JESUDOWICH LMSW

MEDICARE: DEBRA JESUDOWICH 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
11041C0700XClinical Social Worker6851116167MI
21041C0700XClinical Social Worker6801120917MI

General Provider Information

NPI Number : 1174211791
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA JESUDOWICH LMSW
Provider Business Mailing Address
First Line : 4558 WILKSHIRE AVE SW
Second Line :
City : WYOMING
State : MI
Zip : 49548-4156
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1115 BALL AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-5904
Country : US
Telephone Number : 989-331-1805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2023
Last Update Date : 12/10/2025

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Directions to “ DEBRA JESUDOWICH LMSW” Practice Location

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