Provider Demographics
NPI:1710044359
Name:ACKER, JANICE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:ACKER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138
Mailing Address - Country:US
Mailing Address - Phone:734-675-9700
Mailing Address - Fax:734-675-9701
Practice Address - Street 1:23933 ALLEN RD
Practice Address - Street 2:#15
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183
Practice Address - Country:US
Practice Address - Phone:734-675-9700
Practice Address - Fax:734-675-9701
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM6301011306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
M89370Medicare UPIN
MION73680Medicare ID - Type Unspecified