Healthcare Provider Details

I. General information

NPI: 1558277764
Provider Name (Legal Business Name): LAUREN MIKELLE DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSY MIKELLE BJORNLIE

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 E NORTHFIELD BLVD UNIT 3700
DENVER CO
80238-3135
US

IV. Provider business mailing address

1701 W TUCKEY LN UNIT 206
PHOENIX AZ
85015-1711
US

V. Phone/Fax

Practice location:
  • Phone: 480-757-8090
  • Fax:
Mailing address:
  • Phone: 801-380-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: