Provider Demographics
NPI:1376915264
Name:OAKLAND UNIVERSITY ABA CLINIC
Entity Type:Organization
Organization Name:OAKLAND UNIVERSITY ABA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KORNEDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:248-370-7080
Mailing Address - Street 1:2200 N SQUIRREL RD
Mailing Address - Street 2:260 D PAWLEY HALL
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4402
Mailing Address - Country:US
Mailing Address - Phone:248-370-3052
Mailing Address - Fax:
Practice Address - Street 1:2200 N SQUIRREL RD
Practice Address - Street 2:260 D PAWLEY HALL
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48309-4402
Practice Address - Country:US
Practice Address - Phone:248-370-3052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty