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NPI Code Detail

MEDICARE: JANEISHA RANDALL

MEDICARE: JANEISHA RANDALL
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1083146138
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANEISHA RANDALL
Provider Business Mailing Address
First Line : 16133 COYLE ST
Second Line :
City : DETROIT
State : MI
Zip : 48235-3849
Country : US
Telephone Number : 313-459-7969
Fax Number :
Provider Business Practice Location Address
First Line : 9641 HARPER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48213-2731
Country : US
Telephone Number : 313-961-4890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2017
Last Update Date : 03/29/2017

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Directions to “ JANEISHA RANDALL ” Practice Location

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