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General NPI Number Information
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NPI Number | 1083580468
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Entity Type | Individual
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Provider Name | GRACE JULES ROST RBT
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Gender | Female
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 23800 NORTHWESTERN HWY STE 190L
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7740
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Country | US
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Telephone | 734-934-1322
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Fax |
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Provider Business Mailing Address
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Address Line | 44463 BAYVIEW AVE APT 31213
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-7343
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Country | US
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Telephone | 248-525-1298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-338647
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License Number State | MI
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