Provider Demographics
NPI:1023577665
Name:MACKAY, JENNIFER (BSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MACKAY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:MI
Mailing Address - Zip Code:49421-9403
Mailing Address - Country:US
Mailing Address - Phone:616-717-8191
Mailing Address - Fax:
Practice Address - Street 1:9070 8TH ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-9403
Practice Address - Country:US
Practice Address - Phone:616-717-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker