Provider Demographics
NPI:1073363636
Name:SIMERSON, LIAM J
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:J
Last Name:SIMERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 FOSS DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1718
Mailing Address - Country:US
Mailing Address - Phone:989-327-0379
Mailing Address - Fax:
Practice Address - Street 1:7110 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9310
Practice Address - Country:US
Practice Address - Phone:989-450-3498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician