Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | ||
N | 156F00000X | Technician/Technologist |
NPI | 1295394013 |
---|---|
Provider Name | Miss Mackenzie Cleland |
First Address | Farmington Hills, MI 48334-5326 |
Second Address | Farmington Hills, MI 48334-5326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2019 |
Last Update Date | 06/09/2019 |