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General NPI Number Information
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NPI Number | 1063821676
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Entity Type | Individual
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Provider Name | TANYA VANILLO
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Gender | Female
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 910 SPRING ST STE 4
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City | PETOSKEY
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State | MI
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Zip | 49770-2881
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Country | US
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Telephone | 231-268-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 223 BRIDGE ST APT C
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1400
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Country | US
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Telephone | 562-209-1819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401002605
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License Number State | MI
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