Healthcare Provider Details

I. General information

NPI: 1669096749
Provider Name (Legal Business Name): JORDAN RAMSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CORPORATE DR # 2614
TROY MI
48098-2859
US

IV. Provider business mailing address

571 E SARATOGA ST
FERNDALE MI
48220-2824
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-1210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: