Provider Demographics
NPI:1679025092
Name:JAWAD, ALISON (BCABA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:JAWAD
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY PEDIATRICIANS AUTISM CENTER
Mailing Address - Street 2:4501 WOODWARD AVE - SUITE 101
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-577-6143
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY PEDIATRICIANS AUTISM CENTER
Practice Address - Street 2:4501 WOODWARD AVE - SUITE 101
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-577-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst