Individual
MEGAN LYNN GENOVESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1651 E NICKERSON AVE, BENTON HARBOR, MI 49022-2469
(269) 983-5833
Mailing address
1651 E NICKERSON AVE, BENTON HARBOR, MI 49022-2469
(269) 983-5833
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891917449
LOGAN COMMUNITY RESOURCES, INC.
IN
Enumeration date
01/25/2018
Last updated
10/25/2019
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