MEDICARE: TANYA VANILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7401002605	MI

General Provider Information

NPI Number	:	1063821676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA VANILLO

Provider Business Mailing Address
First Line	:	223 BRIDGE ST APT C
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-1400
Country	:	US
Telephone Number	:	562-209-1819
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 SPRING ST STE 4
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2881
Country	:	US
Telephone Number	:	231-268-0007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	02/09/2026

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Directions to “ TANYA VANILLO ” Practice Location

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