Healthcare Provider Details

I. General information

NPI: 1346390804
Provider Name (Legal Business Name): LAURA HANSON TAYLOR MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 IRONWOOD DR STE C FAMILY SUPPORT SERVICES OF NORTH IDAHO
COUER D ALENE ID
83814
US

IV. Provider business mailing address

1115 IRONWOOD DR STE C FAMILY SUPPORT SERVICES OF NORTH IDAHO
COUER D ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-769-4222
  • Fax: 208-667-7557
Mailing address:
  • Phone: 208-769-4222
  • Fax: 208-667-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27312
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: