Healthcare Provider Details

I. General information

NPI: 1548775653
Provider Name (Legal Business Name): BIANCA CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CORNELL RD
YPSILANTI MI
48197-1657
US

IV. Provider business mailing address

9206 PARKWOOD ST
BELLEVILLE MI
48111-1611
US

V. Phone/Fax

Practice location:
  • Phone: 734-487-2890
  • Fax:
Mailing address:
  • Phone:
  • 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: