Healthcare Provider Details

I. General information

NPI: 1811701782
Provider Name (Legal Business Name): BIANCA ELIZABETH MOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52585 DEQUINDRE RD
ROCHESTER HILLS MI
48307-2321
US

IV. Provider business mailing address

195 KALHAVEN RD
ROCHESTER HILLS MI
48307-3841
US

V. Phone/Fax

Practice location:
  • Phone: 248-726-3000
  • Fax:
Mailing address:
  • Phone: 248-878-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009956
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: