Provider Demographics
NPI:1023445525
Name:AYLOR, JENNIE SUE (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:SUE
Last Name:AYLOR
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 GRAND HAVEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5985
Mailing Address - Country:US
Mailing Address - Phone:231-215-9684
Mailing Address - Fax:
Practice Address - Street 1:5353 GRAND HAVEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5985
Practice Address - Country:US
Practice Address - Phone:231-215-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional