Healthcare Provider Details

I. General information

NPI: 1538954169
Provider Name (Legal Business Name): JASMINE IONIE HOBSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 BRIGHTON LAKE RD
BRIGHTON MI
48116-1738
US

IV. Provider business mailing address

14748 BEECH DALY RD
REDFORD MI
48239-3230
US

V. Phone/Fax

Practice location:
  • Phone: 313-228-6143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009962
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: