Jessica Amber Bazan Deraedt, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801101750 Issued in MI

Practice address

1108 Homewild Ave
Jackson, MI 49201-1835

Phone

(231) 679-0648

NPI assigned

Feb 15, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1083170963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 HOMEWILD AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011835",
            "telephone_number": "231-679-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 HOMEWILD AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011835",
            "telephone_number": "231-679-0648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZAN DERAEDT",
        "first_name": "JESSICA",
        "middle_name": "AMBER",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-15",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801101750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vaishnavi Sekar Bawa, DPM
• Rachel Bawks, RN
• Audrey P Baxter, RDN
• Joshua Daniel Baxter
• Nyaradzo Baye, LLMSW
• Rosemary Jordon Beals, LPC
• Rynisha Bean
• Erin Beard
• Rachel Beatty
• Kelly Beck, LLPC, MA, CAADC

• Clinical Social Worker in Jackson, MI
• Providers in Jackson, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.