Jaclyn Beth Issner, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301015380 Issued in MI

Practice address

644 Ruffner Ave
Birmingham, MI 48009-1723

Phone

(248) 909-9801

NPI assigned

Aug 16, 2011

Last updated

May 30, 2019By the provider in NPPES

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

• Dr. Jackie Beth Heller 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

Interoperability endpoints

• Direct secure messaging: jissner@direct.dmc.org

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

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1679852115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 RUFFNER AVE",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480091723",
            "telephone_number": "248-909-9801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 RUFFNER AVE",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480091723",
            "telephone_number": "248-909-9801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 Church St",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481091043",
            "country_code": "US",
            "telephone_number": "734-615-7853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISSNER",
        "first_name": "JACLYN",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-16",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "HELLER",
            "middle_name": "BETH",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Insight Healing and Wellness, LLC.
• Insight Psychological Services
• Inspired Wellness, Inc.
• Rimsha Iqbal, M.D.
• Isabelle Toupin, MSW, LLC
• Ivna Care LLC (Assured Home Nursing Services Inc)
• J 2 K Consulting Firm
• Christina Jabro
• Brooke Jackson
• Jaddou Family Dentistry PLLC

• Clinical Psychologist in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; 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.