Provider Demographics
NPI:1891429981
Name:MACKER, JACQUELYN (BSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:MACKER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 CHERRY ST SE APT 3G
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4749
Mailing Address - Country:US
Mailing Address - Phone:810-305-3423
Mailing Address - Fax:
Practice Address - Street 1:320 COMMERCE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4101
Practice Address - Country:US
Practice Address - Phone:616-258-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker