MRS. JESSICA AMBER BAZAN DERAEDT LMSW
NPI 1083170963
Social Worker - Clinical in Jackson, MI

Active since February 15, 2019
1108 HOMEWILD AVE, JACKSON, MI 49201(231) 679-0648 Get Directions Write a Review

NPPES record last updated: July 17, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 17, 2020, Feb 15, 2019 (2 updates tracked since 2019).

About Mrs. Jessica Amber Bazan Deraedt Lmsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. JESSICA AMBER BAZAN DERAEDT LMSW (NPI 1083170963) is an individual clinical provider in Jackson, Michigan, licensed in Michigan (6801101750) and active in the NPI registry since February 2019.

NPPES Registry Identity

NPI1083170963
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameMRS. JESSICA AMBER BAZAN DERAEDTCredential: LMSW
Location Address1108 HOMEWILD AVEJackson, MI 49201-1835
Mailing Address1108 Homewild AveJackson, MI 49201-1835 · (231) 679-0648
Sole ProprietorYes
Enumeration DateFebruary 15, 2019
Last NPPES UpdateJuly 17, 20202 updates tracked since enumeration
NPPES CertifiedJuly 17, 2020
NPI 1083170963 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in MI · 6801101750
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
1108 HOMEWILD AVE, Jackson, MI 49201

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Bazan Deraedt's NPI number?

The NPI number for Jessica Bazan Deraedt is 1083170963. It was assigned to this individual provider in the NPPES registry on February 15, 2019.

Where is Jessica Bazan Deraedt located?

Jessica Bazan Deraedt practices at 1108 Homewild Ave, Jackson, MI 49201. The listed phone number is (231) 679-0648.

What is Jessica Bazan Deraedt's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Jessica Bazan Deraedt was last updated on July 17, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.