Provider Demographics
NPI:1093242174
Name:KORESH, AUDREY LYNN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LYNN
Last Name:KORESH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 W VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2034
Mailing Address - Country:US
Mailing Address - Phone:844-854-6878
Mailing Address - Fax:
Practice Address - Street 1:3520 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2034
Practice Address - Country:US
Practice Address - Phone:844-854-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst