Active NPI
Jessica Dawn Clemons, MA, TLLP
- Psychologist
- Dearborn, MI
National Provider Identifier
1013740240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6362010007
- Practice address
- 1 Parklane Blvd Ste 200E
Dearborn, MI 48126-2400 - Phone
- (313) 846-2606
- Fax
- (313) 846-2657
- NPI assigned
- Aug 22, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6362010007 | MI | Primary |
Addresses
Primary practice location
1 Parklane Blvd Ste 200E
Dearborn, MI 48126-2400
Mailing address
6509 Cheyne CT
West Bloomfield, MI 48322-3179
Phone (248) 661-5792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6362010007 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psygenics Inc | Psychologist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1013740240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6509 CHEYNE CT",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223179",
"telephone_number": "248-661-5792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PARKLANE BLVD STE 200E",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481262400",
"telephone_number": "313-846-2606",
"fax_number": "313-846-2657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMONS",
"first_name": "JESSICA",
"middle_name": "DAWN",
"name_prefix": "Ms.",
"credential": "MA, TLLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-22",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6362010007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.