Provider Demographics
NPI:1780334037
Name:POCOCK, JADE MORGAN
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:MORGAN
Last Name:POCOCK
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 1:4214 HARBOUR TOWNE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1439
Mailing Address - Country:US
Mailing Address - Phone:989-492-6753
Mailing Address - Fax:
Practice Address - Street 1:203 S WASHINGTON AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1215
Practice Address - Country:US
Practice Address - Phone:989-793-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374700000X
MI68511165701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374700000XNursing Service Related ProvidersTechnician