MEDICARE: MRS. COLLEEN MARIE MARCINKOSKI

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	247200000X	Other Technician
2	103K00000X	Behavior Analyst	7401001325	MI

General Provider Information

NPI Number	:	1740677327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN MARIE MARCINKOSKI

Provider Business Mailing Address
First Line	:	1423 W BUELL RD
Second Line	:
City	:	OAKLAND
State	:	MI
Zip	:	48363-2329
Country	:	US
Telephone Number	:	586-557-1721
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 W BUELL RD
Second Line	:
City	:	OAKLAND
State	:	MI
Zip	:	48363-2329
Country	:	US
Telephone Number	:	586-557-1721
Fax Number	:

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	12/23/2020

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