Healthcare Provider Details

I. General information

NPI: 1346051133
Provider Name (Legal Business Name): MARIAH ELKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31745 E DITNER DR
ROCKWOOD MI
48173-1014
US

IV. Provider business mailing address

31745 E DITNER DR
ROCKWOOD MI
48173-1014
US

V. Phone/Fax

Practice location:
  • Phone: 248-436-4000
  • Fax:
Mailing address:
  • Phone: 313-723-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: