Individual
JACLYN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, NCSP, TLLP
Contact information
Practice address
1777 AXTELL DR, TROY, MI 48084-4404
(248) 613-5377
Mailing address
1777 AXTELL DR, TROY, MI 48084-4404
(248) 787-3831
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6362009126
MI
103TS0200X
School Psychologist
Primary
SP0000000912649
MI
Other
Enumeration date
10/23/2020
Last updated
10/23/2020
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