Provider Demographics
NPI:1891367975
Name:BULDRA, TAYLOR LYNN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LYNN
Last Name:BULDRA
Suffix:
Gender:
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LYNN
Other - Last Name:SHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 S NAPERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5805
Mailing Address - Country:US
Mailing Address - Phone:630-793-8404
Mailing Address - Fax:
Practice Address - Street 1:2703 SE OTIS CORLEY DR STE 11
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3414
Practice Address - Country:US
Practice Address - Phone:479-339-9678
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-21-152383106S00000X
1-23-67243103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician