Basic Information
| Provider Information | |||||||||
| NPI: | 1306270590 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIELAFF | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | LLMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1123 FOUNTAIN VIEW CIR | ||||||||
| Address2: | |||||||||
| City: | SOUTH LYON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481781568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164604022 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2628 S MILFORD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483574938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104947180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2013 | ||||||||
| LastUpdateDate: | 05/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 4101006585 | MI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.