Basic Information
| Provider Information | |||||||||
| NPI: | 1861720427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASKASK | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 S BIGGS ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481113615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343840076 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1001 S RAISINVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481619754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343848949 | ||||||||
| FaxNumber: | 7342430145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2009 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801087026 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.