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NPI Code Detail

MEDICARE: RILEY MCDOUGALL

MEDICARE: RILEY MCDOUGALL
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
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1922765486
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY MCDOUGALL
Provider Business Mailing Address
First Line : 5505 W ROLLING HILLS DR
Second Line :
City : BRIDGEPORT
State : MI
Zip : 48722-9674
Country : US
Telephone Number : 989-331-0623
Fax Number :
Provider Business Practice Location Address
First Line : 5505 W ROLLING HILLS DR
Second Line :
City : BRIDGEPORT
State : MI
Zip : 48722-9674
Country : US
Telephone Number : 989-331-0623
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2021
Last Update Date : 01/28/2025

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Directions to “ RILEY MCDOUGALL ” Practice Location

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