Provider Demographics
NPI:1003686460
Name:HELZERMAN, JACLYN ELIZABETH
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ELIZABETH
Last Name:HELZERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:ELIZABETH
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9528 OLDE HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9297
Mailing Address - Country:US
Mailing Address - Phone:734-644-0101
Mailing Address - Fax:
Practice Address - Street 1:9528 OLDE HICKORY LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-9297
Practice Address - Country:US
Practice Address - Phone:734-644-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010933581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical