Healthcare Provider Details

I. General information

NPI: 1083341978
Provider Name (Legal Business Name): ADELE BUCK BCBA, MA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31225 JEFFERSON AVE
SAINT CLAIR SHORES MI
48082-1301
US

IV. Provider business mailing address

PO BOX 223220
PITTSBURGH PA
15251-2220
US

V. Phone/Fax

Practice location:
  • Phone: 586-519-6331
  • Fax:
Mailing address:
  • Phone: 586-519-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401002812APP25
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: