Healthcare Provider Details

I. General information

NPI: 1407290711
Provider Name (Legal Business Name): JENNIFER LYN JOHNSON MS LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E. EISENHOWER PKWY EISENHOWER CENTER
ANN ARBOR MI
48108
US

IV. Provider business mailing address

3200 E. EISENHOWER PARKWAY
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-0070
  • Fax: 734-677-0890
Mailing address:
  • Phone: 734-677-0070
  • Fax: 734-677-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number6301010450
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301010450
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: