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NPI Code Detail

MEDICARE: MELISSA DAWN JOUSMA LMSW

MEDICARE: MELISSA DAWN JOUSMA 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
1104100000XSocial Worker6801085490MI
21041C0700XClinical Social Worker6801085490MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609968775
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA DAWN JOUSMA LMSW
Provider Business Mailing Address
First Line : 2745 1/2 84TH ST SW
Second Line :
City : BYRON CENTER
State : MI
Zip : 49315-8841
Country : US
Telephone Number : 616-856-0379
Fax Number :
Provider Business Practice Location Address
First Line : 375 APPLE TREE DR
Second Line :
City : IONIA
State : MI
Zip : 48846-7506
Country : US
Telephone Number : 616-527-1790
Fax Number : 616-527-0538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 04/20/2011

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Directions to “ MELISSA DAWN JOUSMA LMSW” Practice Location

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