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General NPI Number Information
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NPI Number | 1669098588
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Entity Type | Individual
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Provider Name | KIERNAN MAE DOUD BS, BCABA
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Gender | Female
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 315 E WARWICK DR STE E
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City | ALMA
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State | MI
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Zip | 48801-1083
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Country | US
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Telephone | 989-462-0970
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Fax |
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Provider Business Mailing Address
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Address Line | 877 W CURTIS RD
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City | SANFORD
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State | MI
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Zip | 48657-9307
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Country | US
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Telephone | 989-750-5464
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 7402000189
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License Number State | MI
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Taxonomy #2
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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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