Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-133337 | IN |
NPI | 1003420902 |
---|---|
Provider Name | Dedreonna Nisha Woodard |
First Address | Farmington Hills, MI 48334-5312 |
Second Address | Farmington Hills, MI 48334-5312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2020 |
Last Update Date | 13/07/2021 |