Provider Demographics
NPI:1437585494
Name:NORRIS, JEANNIE RUTH (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:JEANNIE
Middle Name:RUTH
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:JEANNIE
Other - Middle Name:RUTH
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, MPA, CAADC
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:517-676-3438
Practice Address - Street 1:325 E LAKE ST STE 28
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2463
Practice Address - Country:US
Practice Address - Phone:231-838-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010954391041C0700X, 104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator