Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5201010106 | MI |
NPI | 1437628955 |
---|---|
Provider Name | Jordan Maciejewski |
First Address | Saginaw, MI 48607-1215 |
Second Address | Saginaw, MI 48607-1215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2018 |
Last Update Date | 11/02/2022 |