Provider Demographics
NPI:1043870769
Name:KOVACICH, TAYLOR (RBT)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:
Last Name:KOVACICH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:KOVACICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:2534 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-1130
Practice Address - Country:US
Practice Address - Phone:440-871-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician