Individual
TIFFANY MICKETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
400 RENAISSANCE CTR STE 2600, DETROIT, MI 48243-1502
(855) 832-6727
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401000816
MI
Other
Enumeration date
06/09/2016
Last updated
09/28/2020
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