Individual
AUTUMN SUZANNE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31950 23 MILE RD, CHESTERFIELD, MI 48047-4655
(586) 228-9991
Mailing address
51145 NICOLETTE DR, CHESTERFIELD, MI 48047-4585
(586) 530-8987
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
164W00000X
Licensed Practical Nurse
Primary
4703126279
MI
Other
Enumeration date
01/14/2020
Last updated
01/28/2025
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