Provider Demographics
NPI:1770525909
Name:FRY, JEANNE E (MSW,LMSW,ACSW)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:E
Last Name:FRY
Suffix:
Gender:F
Credentials:MSW,LMSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W LINCOLN ST
Mailing Address - Street 2:PO BOX 239
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1548
Mailing Address - Country:US
Mailing Address - Phone:989-673-6191
Mailing Address - Fax:
Practice Address - Street 1:323 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1537
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801015419104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker