MEDICARE: SUZANNE R JAMAIL PH D

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
1	103TC0700X	Clinical Psychologist	6301009004	MI

General Provider Information

NPI Number	:	1386031680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE R JAMAIL PH D

Provider Business Mailing Address
First Line	:	5524 S SAGINAW RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-4421
Country	:	US
Telephone Number	:	519-562-3384
Fax Number	:

Provider Business Practice Location Address
First Line	:	5524 S SAGINAW RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-4421
Country	:	US
Telephone Number	:	519-562-3384
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUZANNE R JAMAIL
Credential	:	PH D
Telephone Number	:	519-562-3384

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	04/24/2015

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