Most Relevant Information
Provider Data
| NPI Number: | 1003316241 |
| Provider Name: | KIMBERLY RENEE THELEN |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/14/2018 |
| Last Updated: | 02/14/2018 |
Provider Practice Location
640 SEMINOLE RD
NORTON SHORES
MI
494414720
Practice Location Phone/Fax
| Phone: | 2317283501 |
| Fax: |
Provider Mailing Location
640 SEMINOLE RD
NORTON SHORES
MI
494414720
Provider Mailing Phone/Fax
| Phone: | 2317283501 |
| Fax: |