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General NPI Number Information
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NPI Number | 1740677327
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Entity Type | Individual
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Provider Name | MRS. COLLEEN MARIE MARCINKOSKI
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Gender | Female
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 1423 W BUELL RD
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City | OAKLAND
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State | MI
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Zip | 48363-2329
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Country | US
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Telephone | 586-557-1721
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Fax |
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Provider Business Mailing Address
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Address Line | 1423 W BUELL RD
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City | OAKLAND
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State | MI
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Zip | 48363-2329
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Country | US
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Telephone | 586-557-1721
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401001325
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License Number State | MI
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