Most Relevant Information
Provider Data
| NPI Number: | 1003637778 |
| Provider Name: | TAYLER N PETERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/24/2024 |
| Last Updated: | 10/24/2024 |
Provider Practice Location
3809 LAKE EASTBROOK BLVD SE
GRAND RAPIDS
MI
495465931
Practice Location Phone/Fax
| Phone: | 6166048492 |
| Fax: |
Provider Mailing Location
3809 LAKE EASTBROOK BLVD SE
GRAND RAPIDS
MI
495465931
Provider Mailing Phone/Fax
| Phone: | 6166048492 |
| Fax: |