Provider Demographics
NPI:1932709797
Name:VANDEBERG, TAYLOR ANN (BCBA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:VANDEBERG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANN
Other - Last Name:KUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:3808 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7294
Mailing Address - Country:US
Mailing Address - Phone:605-695-2570
Mailing Address - Fax:
Practice Address - Street 1:101 S REID ST STE 307
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7045
Practice Address - Country:US
Practice Address - Phone:888-517-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1-24-74603103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst