Healthcare Provider Details

I. General information

NPI: 1679140586
Provider Name (Legal Business Name): ASHLEY MARIE KUZATKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42850 GARFIELD RD STE 101
CLINTON TWP MI
48038-5026
US

IV. Provider business mailing address

35061 WOODSIDE DR
RICHMOND MI
48062
US

V. Phone/Fax

Practice location:
  • Phone: 586-295-2750
  • Fax:
Mailing address:
  • Phone: 586-206-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: