Provider Demographics
NPI:1417647918
Name:JEFFERIES, EVIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:EVIE
Middle Name:
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:EVIE
Other - Middle Name:
Other - Last Name:BAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2028 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5157
Mailing Address - Country:US
Mailing Address - Phone:269-598-9185
Mailing Address - Fax:
Practice Address - Street 1:1000 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1282
Practice Address - Country:US
Practice Address - Phone:269-387-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511107921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical