Healthcare Provider Details

I. General information

NPI: 1124494190
Provider Name (Legal Business Name): GRACE KOERBER MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE EYK

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 WESTSHIRE DR
LANSING MI
48917-9764
US

IV. Provider business mailing address

7215 WESTSHIRE DR
LANSING MI
48917-9764
US

V. Phone/Fax

Practice location:
  • Phone: 517-657-2638
  • Fax: 248-712-4381
Mailing address:
  • Phone: 517-657-2638
  • Fax: 248-712-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: