Healthcare Provider Details

I. General information

NPI: 1063323004
Provider Name (Legal Business Name): AZARIYAH SWOPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 WALNUT ST
YPSILANTI MI
48198-3937
US

IV. Provider business mailing address

15892 SPRINGS VILLAGE BLVD
TAYLOR MI
48180-4915
US

V. Phone/Fax

Practice location:
  • Phone: 734-252-5215
  • Fax:
Mailing address:
  • Phone: 734-407-6750
  • 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: