Basic Information
| Provider Information | |||||||||
| NPI: | 1972111789 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEWAYNE COTTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4953 FONTAINE BLVD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486037812 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5447 HAMPTON PL | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486049284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9892527044 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2020 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | COTTON | ||||||||
| AuthorizedOfficialFirstName: | DEWAYNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR TECHNICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9895014362 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.