Healthcare Provider Details

I. General information

NPI: 1750129474
Provider Name (Legal Business Name): ELIZABETH ZIELESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E OAKLEY PARK RD STE 101-B
COMMERCE TOWNSHIP MI
48390-1500
US

IV. Provider business mailing address

23821 CONDON ST
OAK PARK MI
48237-2122
US

V. Phone/Fax

Practice location:
  • Phone: 248-387-5200
  • Fax:
Mailing address:
  • Phone: 248-880-9933
  • 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: