Provider Demographics
NPI:1174737159
Name:LEDOUX, JAYME NICOLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:NICOLE
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JAYME
Other - Middle Name:NICOLE
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:100 NB GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2301
Mailing Address - Country:US
Mailing Address - Phone:586-783-2950
Mailing Address - Fax:586-690-4333
Practice Address - Street 1:511 FORT ST RM 505
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3936
Practice Address - Country:US
Practice Address - Phone:810-966-0099
Practice Address - Fax:810-696-7339
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010922531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical