MEDICARE: JILLIAN TAYLOR CREGGER

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	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1316689896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN TAYLOR CREGGER

Provider Business Mailing Address
First Line	:	505 W GRAND AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-6001
Country	:	US
Telephone Number	:	198-944-4236
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W GRAND AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-6001
Country	:	US
Telephone Number	:	198-944-4236
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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