MEDICARE: JIAWEN LI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1033819669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIAWEN LI

Provider Business Mailing Address
First Line	:	4048 FRANKLIN PARK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1934
Country	:	US
Telephone Number	:	248-819-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	4048 FRANKLIN PARK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1934
Country	:	US
Telephone Number	:	248-819-2288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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Directions to “ JIAWEN LI ” Practice Location

Language	Start Address	Practice Location

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