Healthcare Provider Details

I. General information

NPI: 1053728030
Provider Name (Legal Business Name): JANE KENNEDY BAYS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E GRAND BLVD
DETROIT MI
48207-2529
US

IV. Provider business mailing address

1533 CROOKS RD
ROYAL OAK MI
48067-1304
US

V. Phone/Fax

Practice location:
  • Phone: 313-922-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6801095847
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095847
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: