Jazma Ann Wilson-Miles

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

1134203235 Issued in MI

Practice address

34050 Industrial Rd
Livonia, MI 48150-1306

Phone

(734) 293-0034

Fax

(734) 293-0048

NPI assigned

Aug 22, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Domus Vita

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Livonia, MI
  • NPI 1134203235
  NPD (past)

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408665600000",
    "number": "1366841637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 WILLIAMS ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243786",
            "telephone_number": "248-291-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34050 INDUSTRIAL RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481501306",
            "telephone_number": "734-293-0034",
            "fax_number": "734-293-0048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON-MILES",
        "first_name": "JAZMA",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-22",
        "last_updated": "2014-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MI",
            "license": "1134203235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Carlie Wilson, MSN, PRN, AGCNS-BC
• Dekenia Wilson
• Erik Wilson, GENERAL MANAGER
• Jessica Wilson

• Intellectual & Developmental Disabilities Psychologist in Livonia, MI
• Providers in Livonia, MI by specialty
• Intellectual & Developmental Disabilities Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; 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.