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Jerry Idicula, M.ED., BCBA
NPI 1356711766 · on the registry since 2015
Practice
- Address
- 1332 Maryland St
Grosse Pointe Park, MI 48230 - Phone
- (313) 288-9458
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 103K00000X
103K00000X
- Licence states on file
- MI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-03-27
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan