Provider Demographics
NPI:1104067172
Name:BERNARD, JESSICA J (BSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:BERNARD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5698W US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-9116
Mailing Address - Country:US
Mailing Address - Phone:906-341-8469
Mailing Address - Fax:906-341-1323
Practice Address - Street 1:5698W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-9116
Practice Address - Country:US
Practice Address - Phone:906-341-8469
Practice Address - Fax:906-341-1323
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)