Basic Information
| Provider Information | |||||||||
| NPI: | 1528336583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANDO | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13000 N LAKE RD | ||||||||
| Address2: | |||||||||
| City: | GREGORY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481379623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108360367 | ||||||||
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| Practice Location | |||||||||
| Address1: | 710 E GRAND RIVER AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481161820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8105999591 | ||||||||
| FaxNumber: | 8102226300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2011 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801090797 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 6801090797 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.