MEDICARE: JESSICA BARANSKI

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	156F00000X	Technician/Technologist
2	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1184112245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BARANSKI

Provider Business Mailing Address
First Line	:	32100 TELEGRAPH RD STE 205
Second Line	:
City	:	BINGHAM FARMS
State	:	MI
Zip	:	48025-2454
Country	:	US
Telephone Number	:	248-722-4266
Fax Number	:

Provider Business Practice Location Address
First Line	:	42850 GARFIELD RD STE 101
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5026
Country	:	US
Telephone Number	:	586-295-2750
Fax Number	:

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

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	05/12/2022

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Directions to “ JESSICA BARANSKI ” Practice Location

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