Healthcare Provider Details

I. General information

NPI: 1124694823
Provider Name (Legal Business Name): YAN WING JOYCE CHAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 N 108TH AVE
PHOENIX AZ
85037-5469
US

IV. Provider business mailing address

4170 N 108TH AVE
PHOENIX AZ
85037-5469
US

V. Phone/Fax

Practice location:
  • Phone: 480-751-1957
  • Fax: 832-383-8823
Mailing address:
  • Phone: 480-751-1957
  • Fax: 832-383-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80113
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-164324
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: