Jackie Suzanne Shpak

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301013869 Issued in MI

Practice address

31275 Northwestern Hwy Ste 203
Farmington Hills, MI 48334-2579

Phone

(313) 583-7422

NPI assigned

Nov 1, 2013

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

• Jackie Suzanne Oberdorf Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Law

State licenses

Practice roles

Locations

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.

• Mind Body & Soul Connection LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grand Ledge, MI
  • NPI 1679198444
  NPD Authorized official
• Karen Gallagher LMSW Acsw Professional Counseling SRVS LLC

  • Clinical Social Worker
  • Okemos, MI
  • NPI 1578717245
  NPD

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

{
    "created_epoch": "1383264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1255760195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31275 NORTHWESTERN HWY STE 203",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342579",
            "telephone_number": "313-583-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31275 NORTHWESTERN HWY STE 203",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342579",
            "telephone_number": "313-583-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHPAK",
        "first_name": "JACKIE",
        "middle_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-01",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "OBERDORF",
            "middle_name": "SUZANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tanya Shoucair
• Brenden Shouna
• Nadine Faye Shoup
• Ashley Showell
• Vonetta Showell
• Alora Shreeve
• Archana Shrestha
• Sonika Shrestha
• Sumi Shrestha
• Hannah Shropshire

• Clinical Psychologist in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; 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.