Healthcare Provider Details

I. General information

NPI: 1013823251
Provider Name (Legal Business Name): JENNA MANNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 ELLENBORO DR
TROY MI
48083-5116
US

IV. Provider business mailing address

2669 WILLARD DR
TROY MI
48085-4038
US

V. Phone/Fax

Practice location:
  • Phone: 586-306-3319
  • Fax:
Mailing address:
  • Phone: 586-306-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2656110220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: