MEDICARE: TAYLOR ELIZABETH DORSEY M.ED.

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

General Provider Information

NPI Number	:	1972054385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ELIZABETH DORSEY M.ED.

Provider Business Mailing Address
First Line	:	9593 HUDSON BLVD N UNIT 804
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-4514
Country	:	US
Telephone Number	:	602-820-7679
Fax Number	:

Provider Business Practice Location Address
First Line	:	9593 HUDSON BLVD N UNIT 804
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-4514
Country	:	US
Telephone Number	:	602-820-7679
Fax Number	:

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

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	09/13/2024

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