Provider Demographics
NPI:1902173784
Name:JAMES-WITTEVEEN, JENNIFER LEIGH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:JAMES-WITTEVEEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:JAMES-WITTEVEEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLMSW
Mailing Address - Street 1:2838 S 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-9761
Mailing Address - Country:US
Mailing Address - Phone:331-742-1208
Mailing Address - Fax:
Practice Address - Street 1:2838 S 56TH AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-9761
Practice Address - Country:US
Practice Address - Phone:331-742-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010932401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical