Healthcare Provider Details

I. General information

NPI: 1114842671
Provider Name (Legal Business Name): JESSICA FASSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52585 DEQUINDRE RD
ROCHESTER HILLS MI
48307-2321
US

IV. Provider business mailing address

1836 E 13 MILE RD
MADISON HEIGHTS MI
48071-1539
US

V. Phone/Fax

Practice location:
  • Phone: 248-726-3000
  • Fax:
Mailing address:
  • Phone: 810-542-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: