Healthcare Provider Details

I. General information

NPI: 1649188624
Provider Name (Legal Business Name): JACQUELINE KAY DONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N SELFRIDGE BLVD
CLAWSON MI
48017-1006
US

IV. Provider business mailing address

1212 N SELFRIDGE BLVD
CLAWSON MI
48017-1006
US

V. Phone/Fax

Practice location:
  • Phone: 773-668-9098
  • Fax:
Mailing address:
  • Phone: 773-668-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberFS49457
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: