Healthcare Provider Details

I. General information

NPI: 1033845342
Provider Name (Legal Business Name): JILLIAN M HOMMEL MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8371 S SCENIC DR
MONTAGUE MI
49437-8100
US

IV. Provider business mailing address

8371 S SCENIC DR
MONTAGUE MI
49437-8100
US

V. Phone/Fax

Practice location:
  • Phone: 231-769-0201
  • Fax:
Mailing address:
  • Phone: 231-769-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008055
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: