MEDICARE: MISS YVONNE EILEEN OGRODZINSKI

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
2	390200000X	Student in an Organized Health Care Education/Training Program	4351054112	MI

General Provider Information

NPI Number	:	1619539095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YVONNE EILEEN OGRODZINSKI

Provider Business Mailing Address
First Line	:	3030 STATEN AVE APT 7
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-3795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 STATEN AVE APT 7
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-3795
Country	:	US
Telephone Number	:	517-489-1804
Fax Number	:

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

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	05/07/2025

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