Provider Demographics
NPI:1780040170
Name:ST. CLAIR, KORRI (MA, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:KORRI
Middle Name:
Last Name:ST. CLAIR
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 1:403 E FARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3781
Mailing Address - Country:US
Mailing Address - Phone:810-223-6478
Mailing Address - Fax:
Practice Address - Street 1:403 E FARNUM AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3781
Practice Address - Country:US
Practice Address - Phone:810-223-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS324475454856247200000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other