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NPI Code Detail

MEDICARE: TAYLOR JACOBSON

MEDICARE: TAYLOR JACOBSON
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
1103K00000XBehavior AnalystLBA0812MN

General Provider Information

NPI Number : 1568071249
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR JACOBSON
Provider Business Mailing Address
First Line : 14301 EWING AVE S
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-4885
Country : US
Telephone Number : 952-746-5365
Fax Number :
Provider Business Practice Location Address
First Line : 14301 EWING AVE S
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-4885
Country : US
Telephone Number : 952-746-5350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2020
Last Update Date : 02/18/2026

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