Healthcare Provider Details

I. General information

NPI: 1821549155
Provider Name (Legal Business Name): JACOB P KOBYLARZ M.ED, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14680 NEWBURGH RD
LIVONIA MI
48154-5034
US

IV. Provider business mailing address

14680 NEWBURGH RD
LIVONIA MI
48154-5034
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-8000
  • Fax:
Mailing address:
  • Phone: 616-301-8000
  • Fax:

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: