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NPI Code Detail

MEDICARE: ALLYSON WHITE

MEDICARE: ALLYSON WHITE
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 : 1366224305
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLYSON WHITE
Provider Business Mailing Address
First Line : 420 N ALPINE LAKE DR APT B
Second Line :
City : JACKSON
State : MI
Zip : 49203-6332
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1001 LAURENCE AVE STE E
Second Line :
City : JACKSON
State : MI
Zip : 49202-2980
Country : US
Telephone Number : 517-750-4777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2023
Last Update Date : 01/21/2026

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Directions to “ ALLYSON WHITE ” Practice Location

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