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NPI Code Detail

MEDICARE: KATIE LYNN HUMPHREY

MEDICARE: KATIE LYNN HUMPHREY
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
1103K00000XBehavior Analyst7401001687MI

General Provider Information

NPI Number : 1881125466
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE LYNN HUMPHREY
Provider Business Mailing Address
First Line : 1759 W YOUNGS DITCH RD
Second Line :
City : BAY CITY
State : MI
Zip : 48708-9173
Country : US
Telephone Number : 989-209-3250
Fax Number :
Provider Business Practice Location Address
First Line : 1759 W YOUNGS DITCH RD
Second Line :
City : BAY CITY
State : MI
Zip : 48708-9173
Country : US
Telephone Number : 989-209-3250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2017
Last Update Date : 03/23/2026

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Directions to “ KATIE LYNN HUMPHREY ” Practice Location

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