Healthcare Provider Details

I. General information

NPI: 1871262188
Provider Name (Legal Business Name): JENNIFER ZUMOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31229 PLYMOUTH RD
LIVONIA MI
48150-2105
US

IV. Provider business mailing address

31153 PLYMOUTH RD STE 105
LIVONIA MI
48150-2134
US

V. Phone/Fax

Practice location:
  • Phone: 734-466-5150
  • Fax:
Mailing address:
  • Phone:
  • 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: