Provider Demographics
NPI:1114206463
Name:OVERBAUGH, JAMIE LYNNE (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:OVERBAUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNNE
Other - Last Name:SUCHOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:7332 JOCHAR RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-3021
Mailing Address - Country:US
Mailing Address - Phone:586-202-9157
Mailing Address - Fax:810-821-0610
Practice Address - Street 1:7332 JOCHAR RD
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:MI
Practice Address - Zip Code:48001-3021
Practice Address - Country:US
Practice Address - Phone:586-202-9157
Practice Address - Fax:810-821-0610
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010934741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801093474OtherDEPT OF LICENSING AND REGULATORY AFFAIRS - LICENSED MASTER SOCIAL WORKER (LMSW)