Provider Demographics
NPI:1851663447
Name:REISTERER, MAIJA MARIKA (BCBA)
Entity Type:Individual
Prefix:
First Name:MAIJA
Middle Name:MARIKA
Last Name:REISTERER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MAIJA
Other - Middle Name:MARIKA
Other - Last Name:GRAUDINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48143-0663
Mailing Address - Country:US
Mailing Address - Phone:810-559-2129
Mailing Address - Fax:
Practice Address - Street 1:9520 BLUEWATER DR.
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169
Practice Address - Country:US
Practice Address - Phone:810-599-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst