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General NPI Number Information
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NPI Number | 1710358619
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Entity Type | Individual
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Provider Name | ROSE MARIE DORE-GRACZYK BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2015
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Last Update Date | 10/18/2015
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Provider Practice Location Address
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Address Line | 3111 ELECTRIC AVE
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City | PORT HURON
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State | MI
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Zip | 48060-8127
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Country | US
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Telephone | 810-985-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 50584 HELMANDALE ST
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City | CHESTERFIELD
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State | MI
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Zip | 48047-3636
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Country | US
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Telephone | 586-215-5729
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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 |
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License Number State |
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