Active NPI
Kristin Bennett Wolfgang
- Behavior Technician
- Standish, MI
National Provider Identifier
1104557339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 3727 Deep River Rd
Standish, MI 48658-9458 - Phone
- (989) 860-7152
- NPI assigned
- Jun 20, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
3727 Deep River Rd
Standish, MI 48658-9458
Mailing address
2521 N Elms Rd
Flushing, MI 48433-9423
Phone (866) 498-3909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655683200000",
"number": "1104557339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2521 N ELMS RD",
"city": "FLUSHING",
"state": "MI",
"postal_code": "484339423",
"telephone_number": "866-498-3909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3727 DEEP RIVER RD",
"city": "STANDISH",
"state": "MI",
"postal_code": "486589458",
"telephone_number": "989-860-7152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFGANG",
"first_name": "KRISTIN",
"middle_name": "BENNETT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-20",
"last_updated": "2022-06-20",
"certification_date": "2022-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Standish, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.