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NPI Code Detail

MEDICARE: BREANNA LEIGH TACEY

MEDICARE: BREANNA LEIGH TACEY
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
1106S00000XBehavior TechnicianMI
2103K00000XBehavior Analyst7401001084MI

General Provider Information

NPI Number : 1629614169
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA LEIGH TACEY
Provider Business Mailing Address
First Line : 1414 CORNELL ST
Second Line :
City : BAY CITY
State : MI
Zip : 48708-5561
Country : US
Telephone Number : 989-450-1940
Fax Number :
Provider Business Practice Location Address
First Line : 900 CENTER AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6189
Country : US
Telephone Number : 989-778-0127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2019
Last Update Date : 05/23/2022

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Directions to “ BREANNA LEIGH TACEY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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