MEDICARE: JAYBIRD AND OAK

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

General Provider Information

NPI Number	:	1821951120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYBIRD AND OAK

Provider Business Mailing Address
First Line	:	840 JACKSON AVE # 1008
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-1179
Country	:	US
Telephone Number	:	616-209-8862
Fax Number	:

Provider Business Practice Location Address
First Line	:	4467 CASCADE RD SE STE 4469
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3776
Country	:	US
Telephone Number	:	616-209-8862
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CLINICAL GEROSYCHOLOGIST
Name	:	DR. ALLISON ANA ILEM
Credential	:	PHD, BCBA
Telephone Number	:	616-209-8862

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	01/08/2026

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Directions to “JAYBIRD AND OAK ” Practice Location

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