Provider Demographics
NPI:1841782323
Name:SEIDLER, TAYLOR (BCBA1-21-48540LBA673)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SEIDLER
Suffix:
Gender:F
Credentials:BCBA1-21-48540LBA673
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 KILAUEA AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4264
Mailing Address - Country:US
Mailing Address - Phone:808-238-8798
Mailing Address - Fax:
Practice Address - Street 1:1221 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4271
Practice Address - Country:US
Practice Address - Phone:808-238-8798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X
HI673103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician