Provider Demographics
NPI:1326215229
Name:KARSLAKE QUENBY, JEAN MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:KARSLAKE QUENBY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:QUENBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:410 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1752
Mailing Address - Country:US
Mailing Address - Phone:517-676-5661
Mailing Address - Fax:
Practice Address - Street 1:410 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1752
Practice Address - Country:US
Practice Address - Phone:517-676-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010594301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical