MEDICARE: SKYLAR WILLIAMS GRANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1144177965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR WILLIAMS GRANT

Provider Business Mailing Address
First Line	:	1209 MOUNTAIN ROAD PL NE STE R
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7825
Country	:	US
Telephone Number	:	505-433-8938
Fax Number	:	505-445-4968

Provider Business Practice Location Address
First Line	:	1209 MOUNTAIN ROAD PL NE STE R
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7825
Country	:	US
Telephone Number	:	505-433-8938
Fax Number	:	505-445-4968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “ SKYLAR WILLIAMS GRANT ” Practice Location

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