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Individual provider Active NPI Assistant Behavior Analyst · Grayling, MI

NPI 1922543073 · NPPES record last updated Dec 28, 2016

Key facts

NPI
1922543073
Entity type
Individual (NPI type 1)
Primary specialty
Assistant Behavior Analyst 106E00000X
Practice address
6720 Tomahawk TRL
Grayling, MI 49738
Phone
(989) 915-0764
NPI assigned
Dec 28, 2016
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Assistant Behavior Analyst 106E00000X Yes

Addresses

Primary practice location

6720 Tomahawk TRL
Grayling, MI 49738

Mailing address

6720 Tomahawk TRL
Grayling, MI 49738-8921
Phone (989) 915-0764

Other identifiers

IdentifierTypeStateIssuer
34991694MedicaidMI

Other providers in Grayling, MI

All providers in Grayling, MI · Assistant Behavior Analyst in Michigan

Sources for this page

Verify at the official NPI Registry.