Taylor Marie Van Dera, M.A, BCBA
Individual provider Active NPI Behavior Analyst · Kimberly, WI
NPI 1487480356 · NPPES record last updated Sep 9, 2024
Key facts
- NPI
- 1487480356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 1-24-75327 (WI)
- Practice address
- 569 Carter CT
Kimberly, WI 54136-2201 - Phone
- (920) 739-3009
- NPI assigned
- Sep 9, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-24-75327 | WI | Yes |
Addresses
Primary practice location
569 Carter CT
Kimberly, WI 54136-2201
Mailing address
2212 W Charles St
Appleton, WI 54914-4758
Phone (920) 585-4684
Other providers in Kimberly, WI
- Madeline Taylor
- Stephanie Brianna Ticks
- Ashley Ann Torreano
- Tri County Chiropractic SC
- United Seating and Mobility LLC
- Kathleen Van Roy
- Marina L Verwiel
- Chasity Rose Walter
- Brigid Kathleen Wenzelow
- Pler Yang
All providers in Kimberly, WI · Behavior Analyst in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.