Jacquelyn Clemons, LLBSW

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4300 6TH St
Ecorse, MI 48229-1110

Phone

(313) 724-6192

NPI assigned

Sep 13, 2017

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Foot Care Center PC

  • Podiatrist
  • Berkley, MI
  • NPI 1497827398
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 13, 2017.

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505260800000",
    "number": "1417476151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9348 TOBINE ST",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481743365",
            "telephone_number": "313-285-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 6TH ST",
            "city": "ECORSE",
            "state": "MI",
            "postal_code": "482291110",
            "telephone_number": "313-724-6192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "JACQUELYN",
        "credential": "LLBSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-13",
        "last_updated": "2017-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Titus Bell
• Abraham Hassan Beydoun, DDS
• Tinetra Evett-Taylor Burns, MS, RSST, CAC-M
• C. Upshaw & Associates Consulting
• City of Ecorse
• CNS Hearts of Love Home Care,LLC
• Dean'S Manor Inc.
• Carrie Deblock
• Devoted Transportation Inc.
• Tanya Dickerson

• All providers in Ecorse, MI
• Student in an Organized Health Care Education/Training Program in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; 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.