Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003335217 |
---|---|
Provider Name | Elizabeth Wiegand |
First Address | Bingham Farms, MI 48025-2453 |
Second Address | Bingham Farms, MI 48025-2453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2017 |
Last Update Date | 18/05/2021 |