Individual
JACKLYNN RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6060 DIXIE HWY STE H, CLARKSTON, MI 48346-3476
(248) 270-7210
Mailing address
806 WILLIAMSBURY CT APT 183, WATERFORD, MI 48328-2216
(248) 230-0683
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362009375
MI
Other
Enumeration date
08/10/2021
Last updated
09/19/2022
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