Active NPI
Jenna Soulliere
- Behavior Analyst
- Bay City, MI
National Provider Identifier
1396294054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 7401001159
- Practice address
- 3727 Wilder Rd
Bay City, MI 48706-2367 - Phone
- (989) 860-1425
- NPI assigned
- Sep 22, 2016
- Last updated
- Apr 17, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 7401001159 | MI | Primary |
Addresses
Primary practice location
3727 Wilder Rd
Bay City, MI 48706-2367
Mailing address
1525 Ridgewood Dr
Midland, MI 48642-6425
Phone (989) 205-0168
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7401001159 | MI | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Plus Health Services | Behavior Analyst | Past | Accepting new patients |
| Children's Therapy Corner Inc | Past | Accepting new patients | |
| Mercy Plus Healthcare Services LLC | Behavior Analyst | Past | Accepting new patients |
| Mercy Plus | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Midland, MI
- NPI 1669418562
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Alma, MI
- NPI 1902481658
-
- Behavior Analyst
- Alma, MI
- NPI 1447851233
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681689600000",
"number": "1396294054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 RIDGEWOOD DR",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486426425",
"telephone_number": "989-205-0168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3727 WILDER RD",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487062367",
"telephone_number": "989-860-1425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOULLIERE",
"first_name": "JENNA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-22",
"last_updated": "2023-04-17",
"certification_date": "2023-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": "7401001159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.