Provider Demographics
NPI:1619656113
Name:MARTIN, JACLYNNE ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:JACLYNNE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JACLYNNE
Other - Middle Name:ANN
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:37952 SARNETTE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-4033
Mailing Address - Country:US
Mailing Address - Phone:586-945-3676
Mailing Address - Fax:
Practice Address - Street 1:37952 SARNETTE ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-4033
Practice Address - Country:US
Practice Address - Phone:586-945-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010997561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical