Provider Demographics
NPI:1205932746
Name:JACOBS, JESSICA ERIN-GERSHONOWICZ (MSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ERIN-GERSHONOWICZ
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6773 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3013
Mailing Address - Country:US
Mailing Address - Phone:248-661-6100
Mailing Address - Fax:248-661-7347
Practice Address - Street 1:6773 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-661-6100
Practice Address - Fax:248-661-7347
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker