Healthcare Provider Details

I. General information

NPI: 1437747243
Provider Name (Legal Business Name): TAYLOR HOFTIEZER MA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PROFESSIONAL COURT
LAFAYETTE IN
47905
US

IV. Provider business mailing address

80 PROFESSIONAL COURT
LAFAYETTE IN
47905
US

V. Phone/Fax

Practice location:
  • Phone: 765-404-3950
  • Fax: 765-360-1131
Mailing address:
  • Phone: 765-404-3950
  • Fax: 765-360-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68180
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: