| Doctor Name: | JAMIE LORRAINE BODENHAFER |
| NPI Number: | 1508909532 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M.S.W. |
| License Number: | 6801087081 |
| Business Practice Address: | 17657 Avilla Blvd Lathrup Village, MI - 480762732 |
| Business Phone Number: | 2482593527 |
| Business Fax Number: | 2485572008 |
| Mailing Address: | 17657 Avilla Blvd, LATHRUP VILLAGE |
| State: | MI |
| Postal Code: | 480762732 |
| Phone Number: | 2482593527 |
| Fax Number: | 2485572008 |
| NPI Enumeration Date: | 02/15/2007 |
| NPI Last Update Date: | 02/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801087081 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |