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NPI Code Detail

MEDICARE: TIA NIELSEN

MEDICARE: TIA NIELSEN
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 : 1457216129
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIA NIELSEN
Provider Business Mailing Address
First Line : 376 E APPLE AVE
Second Line :
City : MUSKEGON
State : MI
Zip : 49442-3466
Country : US
Telephone Number : 231-724-1111
Fax Number : 231-724-4188
Provider Business Practice Location Address
First Line : 640 SEMINOLE RD
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4720
Country : US
Telephone Number : 231-724-1111
Fax Number : 231-724-4188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2025
Last Update Date : 12/16/2025

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Directions to “ TIA NIELSEN ” Practice Location

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