Provider Demographics
NPI:1861009250
Name:DE LA CRUZ, JESSI MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:MARIE
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-4597
Mailing Address - Country:US
Mailing Address - Phone:517-372-4700
Mailing Address - Fax:517-372-8499
Practice Address - Street 1:1717 N HIGH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4597
Practice Address - Country:US
Practice Address - Phone:517-372-4700
Practice Address - Fax:517-372-8499
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP5028081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical