Provider Demographics
NPI:1144755828
Name:LAYNE, JEANNE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ANN
Last Name:LAYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14867 STONEHAM LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7740
Mailing Address - Country:US
Mailing Address - Phone:313-318-5566
Mailing Address - Fax:
Practice Address - Street 1:2836 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2902
Practice Address - Country:US
Practice Address - Phone:734-627-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018028103TC0700X
MI6301010039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical