Healthcare Provider Details

I. General information

NPI: 1306773486
Provider Name (Legal Business Name): JAYLA MONET HEARST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

20700 CIVIC CENTER DR
SOUTHFIELD MI
48076-4140
US

IV. Provider business mailing address

20700 CIVIC CENTER DR
SOUTHFIELD MI
48076-4140
US

V. Phone/Fax

Practice location:
  • Phone: 800-385-1035
  • Fax:
Mailing address:
  • Phone: 800-385-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: