Provider Demographics
NPI:1548756075
Name:HIGGINBOTHAM, JESSICA MICHELLE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17321 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3132
Mailing Address - Country:US
Mailing Address - Phone:313-255-0900
Mailing Address - Fax:
Practice Address - Street 1:17321 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3132
Practice Address - Country:US
Practice Address - Phone:313-255-0900
Practice Address - Fax:313-255-3465
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator