Healthcare Provider Details

I. General information

NPI: 1467363564
Provider Name (Legal Business Name): JENIPHER SERVIN OLIVARES LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 S INDUSTRIAL DR
SALINE MI
48176-9175
US

IV. Provider business mailing address

196 S INDUSTRIAL DR
SALINE MI
48176-9175
US

V. Phone/Fax

Practice location:
  • Phone: 734-944-3446
  • Fax: 734-316-2093
Mailing address:
  • Phone: 734-944-3446
  • Fax: 734-316-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361007834
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: