Healthcare Provider Details

I. General information

NPI: 1942817465
Provider Name (Legal Business Name): HEATHER ANN REPPERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N STAEBLER RD STE B
ANN ARBOR MI
48103-9862
US

IV. Provider business mailing address

525 VAN NEST ST
DUNDEE MI
48131-1140
US

V. Phone/Fax

Practice location:
  • Phone: 734-252-6522
  • Fax:
Mailing address:
  • Phone: 734-678-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: