Healthcare Provider Details

I. General information

NPI: 1316032469
Provider Name (Legal Business Name): JAYNE AILEEN HEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S TELEGRAPH RD
BLOOMFIELD HILLS MI
48302-0950
US

IV. Provider business mailing address

8061 WARREN BLVD
CENTER LINE MI
48015-1415
US

V. Phone/Fax

Practice location:
  • Phone: 248-322-0001
  • Fax: 248-322-0004
Mailing address:
  • Phone: 586-758-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007145
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: