Provider Demographics
NPI:1144524984
Name:CORTEZ, JESSICA NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:KUSHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1851 ROSEMONT RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1845
Mailing Address - Country:US
Mailing Address - Phone:517-256-0896
Mailing Address - Fax:517-655-3738
Practice Address - Street 1:1086 ORNDORF DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2308
Practice Address - Country:US
Practice Address - Phone:517-256-0896
Practice Address - Fax:517-655-3738
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093949104100000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program