Provider Demographics
NPI:1255585170
Name:HOSEK, JON C (LBSW)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:HOSEK
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ORLEANS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1767
Mailing Address - Country:US
Mailing Address - Phone:517-278-2129
Mailing Address - Fax:517-279-8172
Practice Address - Street 1:200 ORLEANS BLVD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1767
Practice Address - Country:US
Practice Address - Phone:517-278-2129
Practice Address - Fax:517-279-8172
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-03001101YA0400X
MI6802005233171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)