Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-52174 | MI |
N | 156F00000X | Technician/Technologist |
NPI | 1225699796 |
---|---|
Provider Name | Nicole Christine Tedeschi |
First Address | Shelby Township, MI 48315-2705 |
Second Address | Shelby Township, MI 48315-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 29/10/2021 |