Healthcare Provider Details

I. General information

NPI: 1568997047
Provider Name (Legal Business Name): TAYLOR OPSAHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 N EOLA RD
AURORA IL
60502-9612
US

IV. Provider business mailing address

960 ANNANDALE DR
ELGIN IL
60123-6502
US

V. Phone/Fax

Practice location:
  • Phone: 630-999-0401
  • Fax:
Mailing address:
  • Phone: 630-450-6273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-30693
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31924
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: