Provider Demographics
NPI:1780993659
Name:JETT, RAESHAWNDRA CHEIRIE (LLMSW)
Entity type:Individual
Prefix:MS
First Name:RAESHAWNDRA
Middle Name:CHEIRIE
Last Name:JETT
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2911
Mailing Address - Country:US
Mailing Address - Phone:208-705-0604
Mailing Address - Fax:
Practice Address - Street 1:4238 COMMONWEALTH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2911
Practice Address - Country:US
Practice Address - Phone:208-705-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010925541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical