MEDICARE: EMILY ROSE LAXSON MA, BCBA/LBA

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	103K00000X	Behavior Analyst	1238	NC

General Provider Information

NPI Number	:	1831769173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ROSE LAXSON MA, BCBA/LBA

Provider Business Mailing Address
First Line	:	3146 HILLANDALE RD APT 202
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-2295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 N ROXBORO ST STE 150
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2592
Country	:	US
Telephone Number	:	919-739-2489
Fax Number	:

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	12/13/2025

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