Provider Demographics
NPI:1609428960
Name:GUGLIELMI, JENNIFER (RSST, QIDP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GUGLIELMI
Suffix:
Gender:F
Credentials:RSST, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMUNITY LIVING SERVICES, KENT COUNTY DIVISION
Mailing Address - Street 2:642 EAST NINE MILE ROAD
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220
Mailing Address - Country:US
Mailing Address - Phone:248-547-2668
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY LIVING SERVICES, KENT COUNTY DIVISION
Practice Address - Street 2:642 EAST NINE MILE ROAD
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220
Practice Address - Country:US
Practice Address - Phone:248-547-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085528171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator