Healthcare Provider Details

I. General information

NPI: 1548190267
Provider Name (Legal Business Name): JENNIFER GREENLEE SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

106 ORCHARD ST
MAYVILLE MI
48744-9104
US

IV. Provider business mailing address

1385 CLEAVER RD
CARO MI
48723-9378
US

V. Phone/Fax

Practice location:
  • Phone: 989-843-5456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP0000001179504
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: