Provider Demographics
NPI:1841850054
Name:TAYLOR, ALLYCE NICOLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ALLYCE
Middle Name:NICOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N59W24070 CLOVER DR APT 142
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3788
Mailing Address - Country:US
Mailing Address - Phone:414-213-2094
Mailing Address - Fax:
Practice Address - Street 1:1447 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1348
Practice Address - Country:US
Practice Address - Phone:312-624-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-34725103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst