Basic Information
| Provider Information | |||||||||
| NPI: | 1174979819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACQUARRIE | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 GREEN RD APT 215 | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481983423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482969316 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 N TELEGRAPH RD | ||||||||
| Address2: | BUILDING 32 EAST | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483411032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484568150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2016 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401015375 | MI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | 6301018807 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.