Healthcare Provider Details

I. General information

NPI: 1558975755
Provider Name (Legal Business Name): KATELYN ESTREM BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN MCGRAW

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 EKHART ST SE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2110
  • Fax:
Mailing address:
  • Phone: 616-942-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: