Healthcare Provider Details

I. General information

NPI: 1124976105
Provider Name (Legal Business Name): TAMIKA JENNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41800 HAYES RD # 212
CLINTON TWP MI
48038-1876
US

IV. Provider business mailing address

41800 HAYES RD # 212
CLINTON TWP MI
48038-1876
US

V. Phone/Fax

Practice location:
  • Phone: 586-530-6950
  • Fax:
Mailing address:
  • Phone: 586-530-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA JENNINGS
Title or Position: OWNER
Credential:
Phone: 586-530-6950