Provider Demographics
NPI:1649851379
Name:JANN LA DERE MSW LLC
Entity type:Organization
Organization Name:JANN LA DERE MSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LADERE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-203-3231
Mailing Address - Street 1:616 PETOSKEY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2779
Mailing Address - Country:US
Mailing Address - Phone:231-203-3231
Mailing Address - Fax:231-758-1041
Practice Address - Street 1:616 PETOSKEY ST STE 3
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2779
Practice Address - Country:US
Practice Address - Phone:231-203-3231
Practice Address - Fax:231-758-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty