Provider Demographics
NPI:1578602843
Name:BALDWIN, JENNIFER ANNE-KOVIAK (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE-KOVIAK
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:KOVIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:46360 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2800
Mailing Address - Country:US
Mailing Address - Phone:586-948-0228
Mailing Address - Fax:586-948-0213
Practice Address - Street 1:46360 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2800
Practice Address - Country:US
Practice Address - Phone:586-948-0228
Practice Address - Fax:586-948-0213
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802079779104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker