Active NPI
Alexander Jendrusina, PHD
- Clinical Psychologist
- Ypsilanti, MI
National Provider Identifier
1730728718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301018616
- Practice address
- 1606 S. Huron St.
#972993
Ypsilanti, MI 48197 - Phone
- (734) 222-7459
- NPI assigned
- Dec 23, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301018136 | MI | |
| Clinical Psychologist | 103TC0700X | 6301018616 | MI | Primary |
Addresses
Primary practice location
1606 S. Huron St.
#972993
Ypsilanti, MI 48197
Mailing address
1606 S. Huron St.
#972993
Ypsilanti, MI 48197
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301018136 | MI | MD | Psychologist |
| 6301018616 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718841600000",
"number": "1730728718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1606 S. HURON ST.",
"address_2": "#972993",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "48197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1606 S. HURON ST.",
"address_2": "#972993",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "48197",
"telephone_number": "734-222-7459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENDRUSINA",
"first_name": "ALEXANDER",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-23",
"last_updated": "2024-06-20",
"certification_date": "2024-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301018136",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301018616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ypsilanti, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.