Basic Information
| Provider Information | |||||||||
| NPI: | 1679051650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRABOWSKI | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BOGGIA | ||||||||
| OtherFirstName: | KAYLA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 412031 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022412031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1942944050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12319 HIGHLAND RD STE 301 | ||||||||
| Address2: | |||||||||
| City: | HARTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483532946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109911211 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2018 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | N | Eye and Vision Services Providers | Technician/Technologist | 103K00000X | 7401001578 | MI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.