| Doctor Name: | JENNIFER NIDETZ |
| NPI Number: | 1255722088 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 149015759 |
| Business Practice Address: | 23015 Cheyenne Dr South Lyon, MI - 48178 |
| Business Phone Number: | 7348468297 |
| Business Fax Number: | |
| Mailing Address: | 23015 Cheyenne Dr, SOUTH LYON |
| State: | MI |
| Postal Code: | 48178 |
| Phone Number: | 7348468297 |
| Fax Number: | |
| NPI Enumeration Date: | 02/16/2015 |
| NPI Last Update Date: | 02/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149015759 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |