Provider Demographics
NPI:1659267201
Name:CORLISS, JADEN MICHELLE
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:MICHELLE
Last Name:CORLISS
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:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-0741
Mailing Address - Country:US
Mailing Address - Phone:989-846-9631
Mailing Address - Fax:
Practice Address - Street 1:124 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1643
Practice Address - Country:US
Practice Address - Phone:989-401-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician