Healthcare Provider Details

I. General information

NPI: 1750705562
Provider Name (Legal Business Name): CLAUDIA RIDDELL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 FORD RD UNIT 229
WESTLAND MI
48185-3769
US

IV. Provider business mailing address

36500 FORD RD UNIT 229
WESTLAND MI
48185-3769
US

V. Phone/Fax

Practice location:
  • Phone: 866-752-0899
  • Fax: 203-604-0602
Mailing address:
  • Phone: 866-752-0899
  • Fax: 203-604-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-11752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: