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General NPI Number Information
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NPI Number | 1609310846
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Entity Type | Individual
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Provider Name | KATHERINE VINCENT LBA
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Gender | Female
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 6555 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-2713
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Country | US
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Telephone | 586-228-9902
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Fax |
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Provider Business Mailing Address
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Address Line | 51145 NICOLETTE DR
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City | CHESTERFIELD
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State | MI
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Zip | 48047-4585
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Country | US
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Telephone | 586-228-9991
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401001113
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License Number State | MI
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