Individual
TAYLOR MARIE VAN DERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A, BCBA
Contact information
Practice address
569 CARTER CT, KIMBERLY, WI 54136-2201
(920) 739-3009
Mailing address
2212 W CHARLES ST, APPLETON, WI 54914-4758
(920) 585-4684
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-75327
WI
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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