Provider Demographics
NPI:1013522531
Name:CLINE, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8123
Mailing Address - Country:US
Mailing Address - Phone:989-444-8446
Mailing Address - Fax:
Practice Address - Street 1:32 S HOMER RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8367
Practice Address - Country:US
Practice Address - Phone:989-444-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician