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NPI Code Detail

MEDICARE: MISTY WEINER

MEDICARE: MISTY WEINER
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 : 1790135374
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY WEINER
Provider Business Mailing Address
First Line : 7681 WALNUT AVE
Second Line :
City : JENISON
State : MI
Zip : 49428-7941
Country : US
Telephone Number : 989-330-3455
Fax Number :
Provider Business Practice Location Address
First Line : 3290 W BIG BEAVER RD STE 510
Second Line :
City : TROY
State : MI
Zip : 48084-2917
Country : US
Telephone Number : 616-370-3097
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2016
Last Update Date : 10/22/2024

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Directions to “ MISTY WEINER ” Practice Location

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