Healthcare Provider Details

I. General information

NPI: 1972440295
Provider Name (Legal Business Name): TALIA JABLONSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15146 16TH AVE
MARNE MI
49435-9605
US

IV. Provider business mailing address

3849 YORKLAND DR NW APT 3
COMSTOCK PARK MI
49321-8104
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-3326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: