Provider Demographics
NPI:1407352875
Name:PEARSON, IAN JOSEPH (MA, BCBA, LABA)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:JOSEPH
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MA, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 JOSLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3309
Mailing Address - Country:US
Mailing Address - Phone:616-490-3534
Mailing Address - Fax:
Practice Address - Street 1:941 JOSLIN ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3309
Practice Address - Country:US
Practice Address - Phone:616-490-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-20-41869103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty