Provider Demographics
NPI:1972862852
Name:JESKE-MAHLER, CHARISSA ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CHARISSA
Middle Name:ANN
Last Name:JESKE-MAHLER
Suffix:
Gender:F
Credentials:LMSW
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 249
Mailing Address - Street 2:
Mailing Address - City:WATERSMEET
Mailing Address - State:MI
Mailing Address - Zip Code:49969-0249
Mailing Address - Country:US
Mailing Address - Phone:906-358-0252
Mailing Address - Fax:906-358-0254
Practice Address - Street 1:E23968 POWWOW TRL
Practice Address - Street 2:
Practice Address - City:WATERSMEET
Practice Address - State:MI
Practice Address - Zip Code:49969-0249
Practice Address - Country:US
Practice Address - Phone:906-358-0252
Practice Address - Fax:906-358-0254
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01112101YA0400X
MI68010899711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)