IndividualActive
Jessica Bazan Deraedt, LMSW
NPI 1083170963 · Clinical Social Worker · Jackson, MI
Provider details
- NPI number
- 1083170963
- Entity type
- Individual
- Primary specialty
- Clinical Social WorkerBehavioral Health & Social Service Providers
- Credential
- LMSW
- Sex
- Female
- Sole proprietor
- Yes
- License
- 6801101750 (MI)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(66/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1108 Homewild Ave
Jackson, MI 49201-1835
Phone: (231) 679-0648
Street-level locationGet directions
Mailing address
1108 Homewild Ave
Jackson, MI 49201-1835
Registry dates
- Enumerated
- 2019-02-15
- Last updated
- 2020-07-17
- Certified
- 2020-07-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.