Provider Demographics
NPI:1366119216
Name:SMENDIK, JARED MICHAEL (PSYD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:SMENDIK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 COOLIDGE HWY APT 203
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3644
Mailing Address - Country:US
Mailing Address - Phone:269-908-6706
Mailing Address - Fax:
Practice Address - Street 1:39150 DEQUINDRE RD STE 100
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6983
Practice Address - Country:US
Practice Address - Phone:586-580-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical