JACLYN TUCKER (NPI# 1457950172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457950172 |
| Entity Type | Individual |
| Full Name | JACLYN TUCKER |
| Credential | MA, NCSP, TLLP |
| Practice Address |
1777 Axtell Dr Troy MI 48084-4404 |
| Practice Telephone | 2486135377 |
| Mailing Telephone | 2487873831 |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
6362009126 | MI | Behavioral Health & Social Service Providers |
| Y | 103TS0200X |
Psychologist Specialization: School |
SP0000000912649 | MI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437799558 | Jaclyn Tucker | Behavior Technician | 1166 S Gilbert Road, Suite 106, Mesa, AZ 85296 | 2020-01-07 |
| 1851722177 | Jaclyn Tucker | Physician Assistant | 6011 Harry Hines Blvd, Suite V4.114, Dallas, TX 75235-5386 | 2013-12-12 |
| Street Address |
1777 AXTELL DR |
| City | TROY |
| State | MI |
| Zip Code | 48084-4404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639152093 | Miles S Auster | Internal Medicine | 1777 Axtell Dr, Suite 205, Troy, MI 48084-4404 | 2005-11-21 |
| 1124635909 | Quinette Bowman | Counselor | 1777 Axtell Dr, Troy, MI 48084-4404 | 2020-09-25 |
| 1821611567 | Noor Al-omari | Social Worker | 1777 Axtell Dr, Troy, MI 48084-4404 | 2020-05-27 |
| 1013566496 | Rachel Blanchette | Marriage & Family Therapist | 1777 Axtell Dr, Troy, MI 48084-4404 | 2019-09-08 |
| 1063065415 | Rula Ramzi Mohammad | Psychologist | 1777 Axtell Dr, Troy, MI 48084-4404 | 2019-07-24 |
| 1063074920 | Allison Sarah Mckee | Social Worker | 1777 Axtell Dr, Troy, MI 48084-4404 | 2019-07-01 |
| 1235790817 | Birch Ryder Snogles | Marriage & Family Therapist | 1777 Axtell Dr, Troy, MI 48084-4404 | 2019-06-25 |
| 1730746686 | Anita Hakim | Counselor | 1777 Axtell Dr, Troy, MI 48084-4404 | 2019-05-28 |
| 1386116556 | Andreia De Almeida Schulte | Psychologist | 1777 Axtell Dr, Troy, MI 48084-4404 | 2018-12-27 |
| 1962971705 | Jennifer Y West | Psychologist | 1777 Axtell Dr, Troy, MI 48084-4404 | 2018-11-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497360242 | Keely Erin Zuri | Physical Therapy Assistant | 3250 W. Big Beaver, Troy, MI 48084 | 2020-09-09 |
| 1841762473 | Hunter Thomas Michaels | Kinesiotherapist | 3250 West Big Beaver Rd, Suite 228, Troy, MI 48084 | 2018-12-20 |
| 1265900864 | Michelle Denise Carter | Massage Therapist | 3250 West Big Beaver Suite 228, Troy, MI 48084 | 2018-11-13 |
| 1770083925 | Troy Daniel Burrell | Clinical Exercise Physiologist | 3250 West Big Beaver Rd, Suite 228, Troy, MI 48084 | 2018-02-14 |
| 1174030175 | Alexander Scott | Kinesiotherapist | 3250 W. Big Beaver Rd., Troy, MI 48084 | 2017-12-29 |
| 1568977213 | Mallory Rose Valeri | Specialist/Technologist | 3250 W. Big Beaver Rd, Suite 228, Troy, MI 48084 | 2017-12-04 |
| 1710409651 | Eduardo Martin Pinto | Pharmacist | 3811 Coolidge Hwy, Troy, MI 48084 | 2017-07-12 |
| 1659891653 | Tricia Michelle Forgash | Recreation Therapist | 1998 Dorchester Dr. N 106, Troy, MI 48084 | 2017-06-21 |
| 1851759278 | Lauren Field | Counselor | 3290 W Big Beaver Rd Ste 188, Troy, MI 48084 | 2016-01-30 |
| 1265806939 | Tammy Scott-barney | Nurse Practitioner | 888 W Big Beaver Rd Ste 900, Troy, MI 48084 | 2015-11-18 |
| Find all providers in zip 48084 | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477932309 | Kelli Kazmaier | Psychologist | 151 Staunton Rd, Troy, OH 45373-1451 | 2015-05-26 |
| 1528320157 | Craig Robert Hunter | Psychologist | 529 3rd Ave, Troy, NY 12182-2701 | 2012-06-11 |
| 1104102227 | Jerry Keith Oermann | Psychologist | 2221 Livernois Rd., Ste. 101, Troy, MI 48083 | 2011-11-03 |
| 1124418686 | Kathryn Schwab | Psychologist | 2000 W Stanfield Rd, Troy, OH 45373-2572 | 2015-02-04 |
| 1447640107 | Randy Walters | Psychologist | 701 N Market St, Troy, OH 45373-1421 | 2015-02-02 |
| 1609143536 | Kristin Dews | Psychologist | 2221 Livernois Rd Ste 101, Troy, MI 48083-1603 | 2011-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477161347 | Becky Ann Tiret | Psychologist | 6896 Pleasant Ridge Trl, Saginaw, MI 48603-8677 | 2020-07-16 |
| 1366092298 | Cheyne Stresky | Psychologist | 945 Watersedge Ct, Oxford, MI 48371-3682 | 2019-09-12 |
| 1801456819 | Kenneth Michael Pierson | Psychologist | 100 Bowne St Ne, Grand Rapids, MI 49505-4014 | 2019-06-20 |
| 1831675271 | Katlyn Ploss | Psychologist | 43155 Main St Ste 2300g, Novi, MI 48375-1889 | 2018-07-18 |
| 1205320728 | Ashley L Weinert | Psychologist | 27780 Novi Rd Ste 244, Novi, MI 48377-3427 | 2018-06-18 |
| 1598255481 | Kimberly Kay Wyse | Psychologist | 2520 S University Park Drive, Building D Caat Center, Mount Pleasant, MI 48859 | 2018-05-16 |
| 1306336466 | Jeremy Stembridge | Psychologist | 2520 University Park Bldg D, Mount Pleasant, MI 48858-4464 | 2018-05-15 |
| 1396235321 | Robert Dale Wyse | Psychologist | Central Michigan University Sloan Hall 139, Mt Pleasant, MI 48859-0001 | 2018-05-15 |
| 1295231926 | Nina Marie Elmendorf-steele | Psychologist | 8966 Meadow Ln, Berrien Springs, MI 49103-1479 | 2018-04-02 |
| 1114396413 | Heather Marie Martin | Psychologist | 19190 Kinloch, Redford, MI 48240-2602 | 2015-09-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.