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NPI Code Detail

MEDICARE: JAZMIN LYNN LUELLEN LMSW

MEDICARE: JAZMIN LYNN LUELLEN 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 Worker6801115008MI

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 : 1881191203
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAZMIN LYNN LUELLEN LMSW
Provider Business Mailing Address
First Line : 2790 HEALTH PKWY
Second Line :
City : MT PLEASANT
State : MI
Zip : 48858-6934
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2790 HEALTH PKWY
Second Line :
City : MT PLEASANT
State : MI
Zip : 48858-6934
Country : US
Telephone Number : 989-491-1459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2018
Last Update Date : 11/01/2023

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