Provider Demographics
NPI:1124494190
Name:KOERBER, GRACE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:KOERBER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:EYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2814 WOODCLIFF CIR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3155
Mailing Address - Country:US
Mailing Address - Phone:616-334-5964
Mailing Address - Fax:
Practice Address - Street 1:2814 WOODCLIFF CIR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3155
Practice Address - Country:US
Practice Address - Phone:616-334-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst