Provider Demographics
NPI:1952575706
Name:LYNCH, JESSICA CORSAUT (BA, SST)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:CORSAUT
Last Name:LYNCH
Suffix:
Gender:F
Credentials:BA, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35555 GARFIELD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5517
Mailing Address - Country:US
Mailing Address - Phone:586-792-1654
Mailing Address - Fax:586-792-1656
Practice Address - Street 1:35555 GARFIELD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-5517
Practice Address - Country:US
Practice Address - Phone:586-792-1654
Practice Address - Fax:586-792-1656
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1318715104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker