Provider Demographics
NPI:1992196323
Name:WOIWODE, BENJAMIN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:WOIWODE
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 GRAAFSCHAP RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4547
Mailing Address - Country:US
Mailing Address - Phone:616-403-2450
Mailing Address - Fax:
Practice Address - Street 1:492 GRAAFSCHAP RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4547
Practice Address - Country:US
Practice Address - Phone:616-403-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other