Provider Demographics
NPI:1275358137
Name:MOROZ, JESSICA JENNY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JENNY
Last Name:MOROZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5550
Mailing Address - Country:US
Mailing Address - Phone:248-933-1630
Mailing Address - Fax:
Practice Address - Street 1:6639 CENTURION DR STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8273
Practice Address - Country:US
Practice Address - Phone:231-201-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851109627104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker