MEDICARE: DR. JESSICA OSBURN

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	103T00000X	Psychologist	6301016061	MI

General Provider Information

NPI Number	:	1881094506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA OSBURN

Provider Business Mailing Address
First Line	:	4119 BLUE HERON DR
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1876
Country	:	US
Telephone Number	:	248-499-7667
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 BLUE HERON DR
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1876
Country	:	US
Telephone Number	:	248-499-7667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	08/29/2014

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