Jessica Rose Ellem, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6351004650 Issued in MI

Practice address

2215 Fuller Road
Mental Health Service Line
Ann Arbor, MI 48105

Phone

(734) 769-7100

NPI assigned

Mar 18, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessica Rose Winder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1043079197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7341 WILDERNESS PARK DR APT 303",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481855974",
            "telephone_number": "813-468-8621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 FULLER ROAD",
            "address_2": "MENTAL HEALTH SERVICE LINE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48105",
            "telephone_number": "734-769-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLEM",
        "first_name": "JESSICA",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6351004650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "WINDER",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elizabeth Barber, D.D.S., M.S., P.C.
• Elizabeth Stahl, DPM
• Djoni Elkady
• Ahmed Elkhapery, MBBS
• Benjamin John Ellem, PHD
• Ellen S. Grosh, MD
• Lisa Eller
• Trevor Nathaniel Eller, LMT
• Chandy Ellimoottil, MD
• Stephanie Stiff Ellimoottil, NP

• Clinical Psychologist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.

Verify at the official NPI Registry.