Provider Demographics
NPI:1336674142
Name:SLEDGE, JASMINE CHARLISSA (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:CHARLISSA
Last Name:SLEDGE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W LAKE LANSING RD STE C125
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-9800
Practice Address - Country:US
Practice Address - Phone:800-395-3223
Practice Address - Fax:833-329-6632
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2022-06-07
Deactivation Date:2022-03-19
Deactivation Code:
Reactivation Date:2022-05-13
Provider Licenses
StateLicense IDTaxonomies
MI6801107305104100000X
MI68511073051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker