Provider Demographics
NPI:1306270590
Name:SIELAFF, JENNA RUTH (LLMFT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RUTH
Last Name:SIELAFF
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 FOUNTAIN VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1568
Mailing Address - Country:US
Mailing Address - Phone:616-460-4022
Mailing Address - Fax:
Practice Address - Street 1:2628 S MILFORD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4938
Practice Address - Country:US
Practice Address - Phone:810-494-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-25
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist