MEDICARE: MACY LYNN VANCE RBT

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	SD-LBA128	SD

General Provider Information

NPI Number	:	1467103713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACY LYNN VANCE RBT

Provider Business Mailing Address
First Line	:	2501 W. 26TH STREET
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2446
Country	:	US
Telephone Number	:	605-444-9761
Fax Number	:	605-444-9706

Provider Business Practice Location Address
First Line	:	7110 JORDAN DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8738
Country	:	US
Telephone Number	:	605-791-7400
Fax Number	:

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

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/07/2026

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