Taylor Ann Gustafson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712

Phone

(503) 879-2078

NPI assigned

Apr 11, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Taylor Ann Moody Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: taylor.gustafson.p1@direct.grandronde.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1578026951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15298 SW ROYALTY PKWY # 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972243904",
            "telephone_number": "971-256-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9605 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15298 SW Royalty Pkwy # 300",
            "address_purpose": "LOCATION",
            "city": "Tigard",
            "state": "OR",
            "postal_code": "972243904",
            "country_code": "US",
            "telephone_number": "971-256-4050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "TAYLOR",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "MOODY",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carolyn S Fairfax, MD
• Troyce Fortune
• Amber Foster, CRM
• Shelly Rae Fox
• Jill Goodwin, LPC, MFT, ATR
• Laura L Hale, DDS
• Traci Diane Hamilton
• Tricia Raye Hayden, APRN
• Michael Henry, PWS
• Heidi Kathleen Hicinbothom

• All providers in Grand Ronde, OR
• Behavior Technician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.