Provider Demographics
NPI:1043651094
Name:PERRY, JESSICA LEIGH (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9268 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9273
Mailing Address - Country:US
Mailing Address - Phone:517-930-1904
Mailing Address - Fax:517-507-4888
Practice Address - Street 1:913 W HOLMES RD STE 145
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0435
Practice Address - Country:US
Practice Address - Phone:517-930-1904
Practice Address - Fax:517-507-4888
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010957171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical