Jennifer Nidetz, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801097243 Issued in MI

Practice address

23015 Cheyenne Dr
South Lyon, MI 48178

Phone

(734) 846-8297

NPI assigned

Feb 16, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1424044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424044800000",
    "number": "1255722088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23015 CHEYENNE DR",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "48178",
            "telephone_number": "734-846-8297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23015 CHEYENNE DR",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "48178",
            "telephone_number": "734-846-8297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIDETZ",
        "first_name": "JENNIFER",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-16",
        "last_updated": "2015-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801097243",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015759",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy M Mulrath, LMSW
• Carly B Murray, PT
• Samantha Lynn Murray, D.P.T
• Todd John Nadeau, M.A., LLP
• Natasha Gates DDS, PLLC
• Matthew Alan Niemiec, MPT
• Raymond Nkrumah
• Ronald Nomura, LMT, BCTMB, CPMT
• Novian Care LLC
• Office 5 PLLC

• Clinical Social Worker in South Lyon, MI
• Providers in South Lyon, 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 Feb 16, 2015; 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.