Basic Information
| Provider Information | |||||||||
| NPI: | 1659547057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | JENNI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1695 W 12 MILE RD | ||||||||
| Address2: | 120 | ||||||||
| City: | BERKLEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480722182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486914744 | ||||||||
| FaxNumber: | 2486914745 | ||||||||
| Practice Location | |||||||||
| Address1: | 1695 W 12 MILE RD | ||||||||
| Address2: | 120 | ||||||||
| City: | BERKLEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480722182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486914744 | ||||||||
| FaxNumber: | 2486914745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301013826 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.