MEDICARE: JENNIFER J FITCH 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
1	1041C0700X	Clinical Social Worker	6801088743	MI

General Provider Information

NPI Number	:	1417335076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER J FITCH LMSW

Provider Business Mailing Address
First Line	:	906 SEYMOUR AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2544
Country	:	US
Telephone Number	:	517-798-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 4TH ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4572
Country	:	US
Telephone Number	:	517-798-2098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	06/27/2022

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