Provider Demographics
NPI:1801490602
Name:POTTER, JADEAN IRELAND (LMSW)
Entity type:Individual
Prefix:
First Name:JADEAN
Middle Name:IRELAND
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JADEAN
Other - Middle Name:
Other - Last Name:LAVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8127
Mailing Address - Country:US
Mailing Address - Phone:810-985-8900
Mailing Address - Fax:
Practice Address - Street 1:2415 24TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6414
Practice Address - Country:US
Practice Address - Phone:810-488-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011156281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical