MEDICARE: MRS. JAYDE KENNEDY-BALL PSYD, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	6301016332	MI

General Provider Information

NPI Number	:	1225345077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAYDE KENNEDY-BALL PSYD, LP

Provider Business Mailing Address
First Line	:	2540 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3602
Country	:	US
Telephone Number	:	517-262-0637
Fax Number	:	517-539-5974

Provider Business Practice Location Address
First Line	:	2540 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3602
Country	:	US
Telephone Number	:	517-262-0637
Fax Number	:	517-539-5974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	05/19/2026

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