Healthcare Provider Details

I. General information

NPI: 1851207005
Provider Name (Legal Business Name): ASHLEY NOVICOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CAMPUS DR N
WATERFORD MI
48328-2754
US

IV. Provider business mailing address

1475 TULL DR
WATERFORD MI
48327-1442
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-6400
  • Fax:
Mailing address:
  • Phone: 248-270-6163
  • 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: