Provider Demographics
NPI:1063012367
Name:LABRECQUE, JENNA BRIANNE (MASTER OF SOCIAL WOR)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:BRIANNE
Last Name:LABRECQUE
Suffix:
Gender:F
Credentials:MASTER OF SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 EAST CASTLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508
Mailing Address - Country:US
Mailing Address - Phone:616-888-1120
Mailing Address - Fax:
Practice Address - Street 1:2013 EAST CASTLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-888-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker