Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801109051 | MI |
NPI | 1003109505 |
---|---|
Provider Name | Jillian Leigh Murray |
First Address | Grand Rapids, MI 49548-6927 |
Second Address | Grand Rapids, MI 49548-6927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 19/02/2021 |