Individual
JODIE ILENE MIENTKIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
28116 ORCHARD LAKE RD, FARMINGTON HILLS, MI 48334-3737
(248) 550-0333
Mailing address
28116 ORCHARD LAKE RD, FARMINGTON HILLS, MI 48334-3737
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-26866
MI
Other
Enumeration date
02/23/2018
Last updated
02/23/2018
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