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NPI Code Detail

MEDICARE: JAYD GOGARN LLC

MEDICARE: JAYD GOGARN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor6451020851MI

General Provider Information

NPI Number : 1043947815
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAYD GOGARN LLC
Provider Business Mailing Address
First Line : 26545 AMERICAN DR
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48034-6115
Country : US
Telephone Number : 800-395-3223
Fax Number :
Provider Business Practice Location Address
First Line : 2300 JOLLY OAK RD
Second Line :
City : OKEMOS
State : MI
Zip : 48864-3546
Country : US
Telephone Number : 800-395-3223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2022
Last Update Date : 06/15/2026

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Directions to “ JAYD GOGARN LLC” Practice Location

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