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General NPI Number Information
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NPI Number | 1508628389
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Entity Type | Individual
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Provider Name | AUDREY MARIE JUDGE-PONSTEIN
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 6269 WILMINGTON DR
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City | NORTON SHORES
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State | MI
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Zip | 49444-7890
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Country | US
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Telephone | 231-402-1306
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Fax |
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Provider Business Mailing Address
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Address Line | 126 E MAIN AVE
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City | ZEELAND
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State | MI
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Zip | 49464-1736
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Country | US
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Telephone | 616-900-5001
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Fax | 616-333-8020
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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 |
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License Number State |
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