Healthcare Provider Details

I. General information

NPI: 1154204667
Provider Name (Legal Business Name): JESSICA HAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17461 ALLEN RD
MELVINDALE MI
48122-1026
US

IV. Provider business mailing address

17461 ALLEN RD
MELVINDALE MI
48122-1026
US

V. Phone/Fax

Practice location:
  • Phone: 313-920-8771
  • Fax: 949-561-4887
Mailing address:
  • Phone: 313-920-8771
  • Fax: 949-561-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: