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NPI Code Detail

MEDICARE: MS. KIMBERLY ANN AVESIAN MS, LLP

MEDICARE: MS. KIMBERLY ANN AVESIAN MS, LLP
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
1103T00000XPsychologist6301012918MI

General Provider Information

NPI Number : 1720177041
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY ANN AVESIAN MS, LLP
Provider Business Mailing Address
First Line : 28175 HAGGERTY RD
Second Line :
City : NOVI
State : MI
Zip : 48377-2903
Country : US
Telephone Number : 248-702-4470
Fax Number :
Provider Business Practice Location Address
First Line : 28175 HAGGERTY RD
Second Line :
City : NOVI
State : MI
Zip : 48377-2903
Country : US
Telephone Number : 248-702-4470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 02/26/2025

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