Provider Demographics
NPI:1114778529
Name:SIGGERS, JEMILLA
Entity Type:Individual
Prefix:
First Name:JEMILLA
Middle Name:
Last Name:SIGGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 NECKEL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1478
Mailing Address - Country:US
Mailing Address - Phone:947-258-9046
Mailing Address - Fax:
Practice Address - Street 1:7335 NECKEL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1478
Practice Address - Country:US
Practice Address - Phone:947-258-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician