Provider Demographics
NPI:1447945183
Name:LAWS, JADA L
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:L
Last Name:LAWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5898 DAWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5103
Mailing Address - Country:US
Mailing Address - Phone:248-949-0268
Mailing Address - Fax:
Practice Address - Street 1:23 S PADDOCK ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2623
Practice Address - Country:US
Practice Address - Phone:248-949-0268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No122400000XDental ProvidersDenturist