Healthcare Provider Details

I. General information

NPI: 1699658658
Provider Name (Legal Business Name): TAGNON YANNE ELSIE GLA GBOKEDE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 SAMUEL MORSE DR STE 100-300
COLUMBIA MD
21046-3442
US

IV. Provider business mailing address

8717 YVONNE COURT WAY
PARKVILLE MD
21234-3945
US

V. Phone/Fax

Practice location:
  • Phone: 855-935-3691
  • Fax:
Mailing address:
  • Phone: 443-653-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-455316
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: