Provider Demographics
NPI:1235212960
Name:HARPER, JEANNE M (MPS, FT, BCETS, LBSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:HARPER
Suffix:
Gender:F
Credentials:MPS, FT, BCETS, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-2514
Mailing Address - Country:US
Mailing Address - Phone:715-735-9549
Mailing Address - Fax:906-864-3058
Practice Address - Street 1:447 1ST ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3307
Practice Address - Country:US
Practice Address - Phone:906-864-2590
Practice Address - Fax:906-864-3058
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802065750104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08943500OtherBLUE CROSS BLUE SHIELD
WI39282900Medicaid