MEDICARE: ALEXIS KIANNA GRIFFIN

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		MI

General Provider Information

NPI Number	:	1124975735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS KIANNA GRIFFIN

Provider Business Mailing Address
First Line	:	10201 CHESAPEAKE CIR
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-5905
Country	:	US
Telephone Number	:	248-513-1724
Fax Number	:

Provider Business Practice Location Address
First Line	:	10201 CHESAPEAKE CIR
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-5905
Country	:	US
Telephone Number	:	248-513-1724
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ ALEXIS KIANNA GRIFFIN ” Practice Location

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