Healthcare Provider Details

I. General information

NPI: 1174483515
Provider Name (Legal Business Name): MRS. JEANNAH ROSE OXFORD ABOU ASSALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HOGBACK RD STE 2
ANN ARBOR MI
48105-9735
US

IV. Provider business mailing address

653 DUCHESS ST
MILFORD MI
48381-1101
US

V. Phone/Fax

Practice location:
  • Phone: 734-386-0041
  • Fax:
Mailing address:
  • Phone: 248-202-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: