Provider Demographics
NPI:1578816625
Name:TAYLOR, KATHERINE NOBLE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:NOBLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 WINDHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1763
Mailing Address - Country:US
Mailing Address - Phone:630-759-0201
Mailing Address - Fax:630-759-1005
Practice Address - Street 1:1289 WINDHAM PKWY
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1763
Practice Address - Country:US
Practice Address - Phone:630-759-0201
Practice Address - Fax:630-759-1005
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-12-12090103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst