MEDICARE: NICOLE DEHANKE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1063386787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DEHANKE

Provider Business Mailing Address
First Line	:	24756 ROOSEVELT CT APT 362
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-1871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2591 MCINTOSH CT
Second Line	:
City	:	WOLVERINE LAKE
State	:	MI
Zip	:	48390-1857
Country	:	US
Telephone Number	:	248-245-5622
Fax Number	:

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

Provider Enumeration Date	:	10/04/2025
Last Update Date	:	10/04/2025

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Directions to “ NICOLE DEHANKE ” Practice Location

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