Healthcare Provider Details

I. General information

NPI: 1225345077
Provider Name (Legal Business Name): JAYDE KENNEDY-BALL PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAYDE KENNEDY

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 SPRING ARBOR RD
JACKSON MI
49203-3602
US

IV. Provider business mailing address

2540 SPRING ARBOR RD
JACKSON MI
49203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 517-262-0637
  • Fax: 517-539-5974
Mailing address:
  • Phone: 517-262-0637
  • Fax: 517-539-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: