Basic Information
| Provider Information | |||||||||
| NPI: | 1841862687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYDEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1750 HORIZON DR | ||||||||
| Address2: | |||||||||
| City: | IONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488462028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169025130 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3809 LAKE EASTBROOK BLVD SE STE A | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495465931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166048492 | ||||||||
| FaxNumber: | 6166048493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2021 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801078589 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 6801078589 | 01 | MI | MICHIGAN SOCIAL WORK LICENSE - LMSW | OTHER |