MEDICARE: JENNIFER NICOLE WHORL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1740724053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE WHORL

Provider Business Mailing Address
First Line	:	4201 VARSITY DR STE B
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-5005
Country	:	US
Telephone Number	:	734-369-8594
Fax Number	:	734-369-8565

Provider Business Practice Location Address
First Line	:	4201 VARSITY DR STE B
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-5005
Country	:	US
Telephone Number	:	734-369-8594
Fax Number	:	734-369-8565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/06/2016

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