Individual ProviderJacquelyn Marie ProvenzolaSocial WorkerBehavioral Health & Social Service ProvidersPractice Address4902 Chilson Rd, Howell, MI 48843-9453(248) 385-2524PECOS EnrollmentBased on the most recent information from CMS, provider Jacquelyn Marie Provenzola does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1477114957Provider TypeIndividualFull NameProvenzola, Jacquelyn MarieCredentialLMSWGenderFemaleSole ProprietorNoEnumeration Date6/25/2019Last Updated4/18/2023Contact InformationPractice LocationPractice Address4902 Chilson Rd, Howell, MI 48843-9453Phone(248) 385-2524Fax(844) 640-0684Mailing LocationMailing Address4902 Chilson Rd, Howell, MI 48843-9453Phone(248) 385-2524Fax(844) 640-0684Provider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense6801105007