Healthcare Provider Details

I. General information

NPI: 1477475911
Provider Name (Legal Business Name): DEYONNA DEANNINE TAYLOR BEHAVIOR ANALYST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 LAKELAND AVE N STE 110B
BROOKLYN PARK MN
55428-5615
US

IV. Provider business mailing address

8040 PERRY AVE N
BROOKLYN PARK MN
55443-2421
US

V. Phone/Fax

Practice location:
  • Phone: 763-442-7353
  • Fax:
Mailing address:
  • Phone: 612-210-2195
  • Fax: 763-441-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: