Provider Demographics
NPI:1104837905
Name:MARTIN-DOWNS, JACQUE LYNNE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUE
Middle Name:LYNNE
Last Name:MARTIN-DOWNS
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 1:243 SAINT LAWRENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-1568
Mailing Address - Country:US
Mailing Address - Phone:248-349-4245
Mailing Address - Fax:
Practice Address - Street 1:18922 FARMINGTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3269
Practice Address - Country:US
Practice Address - Phone:800-940-3808
Practice Address - Fax:248-476-7133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010614621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0893970OtherBCBS