Individual
JILL ANN IDICULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
UNIVERSITY PEDIATRICIANS AUTISM CENTER, 16700 17 MILE ROAD SUITE B, CLINTON TOWNSHIP, MI 48038
(586) 228-2300
(586) 228-2307
Mailing address
1800 W BIG BEAVER RD STE 150, TROY, MI 48084-3535
(248) 918-5600
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401001204
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/01/2018
Last updated
04/05/2021
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