Provider Demographics
NPI:1023782034
Name:HENLEY, JACALYN JOY (RN)
Entity type:Individual
Prefix:
First Name:JACALYN
Middle Name:JOY
Last Name:HENLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24763 CHRISTINA LN
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2309
Mailing Address - Country:US
Mailing Address - Phone:313-506-5376
Mailing Address - Fax:248-719-7632
Practice Address - Street 1:24763 CHRISTINA LN
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2309
Practice Address - Country:US
Practice Address - Phone:313-506-5376
Practice Address - Fax:248-719-7632
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty