Provider Demographics
NPI:1164035143
Name:STUART, JALYN ELIZABETH (BSW)
Entity Type:Individual
Prefix:
First Name:JALYN
Middle Name:ELIZABETH
Last Name:STUART
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 1:14440 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MI
Mailing Address - Zip Code:49303-9734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5270 NORTHLAND DR NE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1073
Practice Address - Country:US
Practice Address - Phone:616-915-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801118146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker