Provider Demographics
NPI:1750705562
Name:RIDDELL, CLAUDIA (BCBA)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:RIDDELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36500 FORD RD
Mailing Address - Street 2:UNIT 229
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3769
Mailing Address - Country:US
Mailing Address - Phone:866-752-0899
Mailing Address - Fax:203-604-0602
Practice Address - Street 1:36500 FORD RD
Practice Address - Street 2:UNIT 229
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3769
Practice Address - Country:US
Practice Address - Phone:866-752-0899
Practice Address - Fax:203-604-0602
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-12-11752103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1-12-11752OtherBOARD CERTIFIED BEHAVIOR ANALYST-BCBA