Provider Demographics
NPI:1558004077
Name:MAINO, JANNIFER KIM (LMSW)
Entity Type:Individual
Prefix:
First Name:JANNIFER
Middle Name:KIM
Last Name:MAINO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N DETTMAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8837
Mailing Address - Country:US
Mailing Address - Phone:517-917-2352
Mailing Address - Fax:
Practice Address - Street 1:2825 WIENEKE RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2600
Practice Address - Country:US
Practice Address - Phone:989-262-7385
Practice Address - Fax:989-652-3916
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105433104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker