Provider Demographics
NPI:1295377042
Name:VERMEERSCH, TAYLOR R (BCBA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:R
Last Name:VERMEERSCH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:VERMEERSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:2919 WILDER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9299
Mailing Address - Country:US
Mailing Address - Phone:989-671-5738
Mailing Address - Fax:
Practice Address - Street 1:2919 WILDER RD STE 100
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9299
Practice Address - Country:US
Practice Address - Phone:989-671-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001032103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst