Individual
JENNIFER ISHAQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY MA
Contact information
Practice address
1777 AXTELL DR STE 100, TROY, MI 48084-4400
(248) 862-1171
Mailing address
1273 ROSALIE DR, FENTON, MI 48430-9646
(810) 835-5743
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362009337
MI
Other
Enumeration date
07/30/2020
Last updated
07/27/2022
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