Active NPI
Jennifer Ann Kodrik
- Psychologist
- Plymouth, MI
National Provider Identifier
1588730659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301013094
- Practice address
- 1098 Ann Arbor Rd W # 200
Plymouth, MI 48170-2129 - Phone
- (734) 453-5603
- Fax
- (734) 453-5619
- NPI assigned
- Nov 28, 2006
- Last updated
- Sep 9, 2026
- 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 | 6301013094 | MI | Primary |
Addresses
Primary practice location
1098 Ann Arbor Rd W # 200
Plymouth, MI 48170-2129
Mailing address
45177 Prestbury Rd
Canton, MI 48187-2979
Phone (734) 453-5603
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 |
|---|---|---|---|
| 6301013094 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788912000000",
"number": "1588730659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45177 PRESTBURY RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481872979",
"telephone_number": "734-453-5603",
"fax_number": "734-453-5619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1098 ANN ARBOR RD W # 200",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481702129",
"telephone_number": "734-453-5603",
"fax_number": "734-453-5619"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODRIK",
"first_name": "JENNIFER",
"middle_name": "ANN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2026-09-09",
"certification_date": "2026-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301013094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.