Healthcare Provider Details

I. General information

NPI: 1376922831
Provider Name (Legal Business Name): FINNEGAN JAE BORN LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE STE 3693
WAYNE MI
48184-1668
US

IV. Provider business mailing address

35425 W MICHIGAN AVE STE 3693
WAYNE MI
48184-1668
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-7600
  • Fax:
Mailing address:
  • Phone: 734-467-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802081350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: