Doctor Name: | MS. CHARISSA ANN JESKE |
NPI Number: | 1972862852 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | 2-01112 |
Business Practice Address: | E23968 Powwow Trl Watersmeet, MI - 499690249 |
Business Phone Number: | 9063580252 |
Business Fax Number: | 9063580254 |
Mailing Address: | Po Box 249, WATERSMEET |
State: | MI |
Postal Code: | 499690249 |
Phone Number: | 9063580252 |
Fax Number: | 9063580254 |
NPI Enumeration Date: | 05/11/2012 |
NPI Last Update Date: | 05/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 2-01112 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |