Provider Demographics
NPI:1669052171
Name:SUPERIOR BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:SUPERIOR BEHAVIORAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ZAVODNIK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:616-308-8408
Mailing Address - Street 1:5300 STINSON AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-6313
Mailing Address - Country:US
Mailing Address - Phone:616-308-8408
Mailing Address - Fax:
Practice Address - Street 1:5300 STINSON AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-6313
Practice Address - Country:US
Practice Address - Phone:218-216-7798
Practice Address - Fax:866-882-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty