Provider Demographics
NPI:1538354410
Name:DEJARNATT, JESSICA LAUREL (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREL
Last Name:DEJARNATT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREL
Other - Last Name:DOMBROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:25 SHELDON BLVD. SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-426-3731
Mailing Address - Fax:616-459-0392
Practice Address - Street 1:25 SHELDON BLVD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-426-3731
Practice Address - Fax:616-459-0392
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010866751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical