Healthcare Provider Details

I. General information

NPI: 1972753572
Provider Name (Legal Business Name): SARAH JAYNE JONOVICH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 01/23/2024
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 5TH AVE
ANN ARBOR MI
48104-2216
US

IV. Provider business mailing address

210 S 5TH AVE
ANN ARBOR MI
48104-2216
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-6571
  • Fax:
Mailing address:
  • Phone: 734-615-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301015980
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015980
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: