Provider Demographics
NPI:1255688354
Name:KIDD, JESSICA ANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANNE
Last Name:KIDD
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 1:9012 RACKHAM ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2991
Mailing Address - Country:US
Mailing Address - Phone:773-988-4200
Mailing Address - Fax:
Practice Address - Street 1:29750 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2607
Practice Address - Country:US
Practice Address - Phone:586-777-3200
Practice Address - Fax:586-777-7855
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010946571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical