| Doctor Name: | JEAN CARLSON |
| NPI Number: | 1306210745 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 713 N Center Dr Nw Walker, MI - 495448215 |
| Business Phone Number: | 6166472802 |
| Business Fax Number: | |
| Mailing Address: | 5410 Ada Dr Se, ADA |
| State: | MI |
| Postal Code: | 493017822 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/23/2015 |
| NPI Last Update Date: | 11/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |