Provider Demographics
NPI:1699328559
Name:BARANOWSKI, JESSICA (CADC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BARANOWSKI
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5705
Mailing Address - Country:US
Mailing Address - Phone:989-928-3566
Mailing Address - Fax:989-391-9596
Practice Address - Street 1:1009 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5705
Practice Address - Country:US
Practice Address - Phone:989-928-3566
Practice Address - Fax:989-391-9596
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist