Provider Demographics
NPI:1972230571
Name:ENGLISH, JADE ANNA
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ANNA
Last Name:ENGLISH
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 1:4048 S HINMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTPHALIA
Mailing Address - State:MI
Mailing Address - Zip Code:48894-9249
Mailing Address - Country:US
Mailing Address - Phone:989-640-1434
Mailing Address - Fax:
Practice Address - Street 1:4048 S HINMAN RD
Practice Address - Street 2:
Practice Address - City:WESTPHALIA
Practice Address - State:MI
Practice Address - Zip Code:48894-9249
Practice Address - Country:US
Practice Address - Phone:989-640-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI106S00000XMedicaid