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NPI Code Detail

MEDICARE: MRS. TERESA LEE TAYLOR M.E.S.

MEDICARE: MRS. TERESA LEE TAYLOR M.E.S.
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1862WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P00136897OTHERWINETWORK HEALTH PROV #

General Provider Information

NPI Number : 1275622524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERESA LEE TAYLOR M.E.S.
Provider Business Mailing Address
First Line : 190 GRAND SEASONS DR
Second Line :
City : WAUPACA
State : WI
Zip : 54981-8219
Country : US
Telephone Number : 715-258-8459
Fax Number : 715-258-0878
Provider Business Practice Location Address
First Line : 190 GRAND SEASONS DR
Second Line :
City : WAUPACA
State : WI
Zip : 54981-8219
Country : US
Telephone Number : 715-258-8459
Fax Number : 715-258-0878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/09/2007

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