Provider Demographics
NPI:1528336583
Name:JANDO, DONNA (LMSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:JANDO
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 1:13000 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:MI
Mailing Address - Zip Code:48137-9623
Mailing Address - Country:US
Mailing Address - Phone:810-836-0367
Mailing Address - Fax:
Practice Address - Street 1:710 E GRAND RIVER AVE STE 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1820
Practice Address - Country:US
Practice Address - Phone:810-599-9591
Practice Address - Fax:810-222-6300
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010907971041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical