Individual
MRS. KATHLEEN RUTH CHUBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
7160 TAFT ST, ROMULUS, MI 48174-2149
(734) 757-5602
Mailing address
7160 TAFT ST, ROMULUS, MI 48174-2149
(734) 757-5602
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11936890
MI
247200000X
Other Technician
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497202733
—
MI
Enumeration date
09/02/2016
Last updated
06/27/2019
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