Provider Demographics
NPI:1528058013
Name:FORCHE, JENNIFER R (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:FORCHE
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 1:2477 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4293
Mailing Address - Country:US
Mailing Address - Phone:248-643-7227
Mailing Address - Fax:
Practice Address - Street 1:2477 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-4293
Practice Address - Country:US
Practice Address - Phone:248-643-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2051447OtherCIGNA
MI68-0F34999OtherBCBSM PIN
MI100752502422OtherHUMANA
MI038872OtherVALUE OPTIONS
MI0F34999Medicare ID - Type Unspecified