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General NPI Number Information
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NPI Number | 1275354896
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Entity Type | Individual
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Provider Name | ZOE MATSON BROADUS BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | FUNCTIONAL BEHAVIOR SERVICES 2353 BADGER STREET
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City | MARQUETTE
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State | MI
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Zip | 49855-2302
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Country | US
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Telephone | 906-273-1121
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Fax | 906-225-6706
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Provider Business Mailing Address
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Address Line | 2353 BADGER STREET
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City | MARQUETTE
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State | MI
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Zip | 49855-2302
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Country | US
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Telephone | 906-273-1121
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Fax | 906-225-6706
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1275354896
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License Number State | MI
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