Provider Demographics
NPI:1366072316
Name:TAYLOR, LAURA LOUISE (MA/CDP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA/CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E OLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1434
Mailing Address - Country:US
Mailing Address - Phone:608-219-0136
Mailing Address - Fax:
Practice Address - Street 1:210 E OLIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1434
Practice Address - Country:US
Practice Address - Phone:360-528-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty