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NPI Code Detail

MEDICARE: AUDREY BELLE RATHJENS

MEDICARE: AUDREY BELLE RATHJENS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1821920687
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY BELLE RATHJENS
Provider Business Mailing Address
First Line : 4234 CASCADE RD SE STE 3
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8384
Country : US
Telephone Number : 888-614-4144
Fax Number : 888-614-4144
Provider Business Practice Location Address
First Line : 4234 CASCADE RD SE STE 3
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8384
Country : US
Telephone Number : 888-614-4144
Fax Number : 888-614-4144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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