Provider Demographics
NPI:1225693922
Name:DOYLE, JESSIKA EVELYN (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:EVELYN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 N NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9729
Mailing Address - Country:US
Mailing Address - Phone:989-284-1486
Mailing Address - Fax:
Practice Address - Street 1:520 N MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1171
Practice Address - Country:US
Practice Address - Phone:231-445-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010969071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical