Provider Demographics
NPI:1689222606
Name:BUCKNER, JESSICA LYNNE (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4178 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-7727
Mailing Address - Country:US
Mailing Address - Phone:517-292-9373
Mailing Address - Fax:
Practice Address - Street 1:2020 E GRAND RIVER AVE STE 104
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2478
Practice Address - Country:US
Practice Address - Phone:517-545-5944
Practice Address - Fax:517-518-8275
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator