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NPI Code Detail

MEDICARE: JODY NELSON RSW

MEDICARE: JODY NELSON RSW
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
1104100000XSocial Worker6801074609MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11609721125OTHERMINPI GROUP

General Provider Information

NPI Number : 1376591446
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODY NELSON RSW
Provider Business Mailing Address
First Line : 1092 SAINT JOHNS CHASE
Second Line :
City : GRAND LEDGE
State : MI
Zip : 48837-9781
Country : US
Telephone Number : 517-526-0036
Fax Number :
Provider Business Practice Location Address
First Line : 411 W LAKE LANSING RD STE A100
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-8404
Country : US
Telephone Number : 517-526-0036
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 05/06/2026

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