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General NPI Number Information
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NPI Number | 1821951120
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Entity Type | Organization
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Legal Business Name | JAYBIRD AND OAK, PLLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 4467 CASCADE RD SE STE 4469
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3776
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Country | US
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Telephone | 616-209-8862
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Fax |
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Provider Business Mailing Address
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Address Line | 840 JACKSON AVE # 1008
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City | GRAND HAVEN
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State | MI
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Zip | 49417-1179
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Country | US
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Telephone | 616-209-8862
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL GEROSYCHOLOGIST
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Name | DR. ALLISON ANA ILEM
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Credential | PHD, BCBA
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Telephone | 616-209-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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