Provider Demographics
NPI:1427294636
Name:ROEBLING, JERILYN JEAN (LMSW)
Entity type:Individual
Prefix:
First Name:JERILYN
Middle Name:JEAN
Last Name:ROEBLING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49463 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064-8706
Mailing Address - Country:US
Mailing Address - Phone:269-674-3186
Mailing Address - Fax:
Practice Address - Street 1:3285 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:800-795-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010162921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical