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NPI Code Detail

MEDICARE: KATHRYN RANKIN

MEDICARE: KATHRYN RANKIN
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 : 1215470539
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN RANKIN
Provider Business Mailing Address
First Line : 5479 W ROSEBUD CT
Second Line :
City : KENTWOOD
State : MI
Zip : 49512
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4234 CASCADE RD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8384
Country : US
Telephone Number : 248-200-9710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2016
Last Update Date : 02/21/2022

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