Provider Demographics
NPI:1063129005
Name:GOLDSMITH, JESSICA ERIN SAUSTO (MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN SAUSTO
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 CANOE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1887
Mailing Address - Country:US
Mailing Address - Phone:636-293-2933
Mailing Address - Fax:
Practice Address - Street 1:3250 UNIVERSITY DR STE 115
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2391
Practice Address - Country:US
Practice Address - Phone:248-844-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health