Healthcare Provider Details

I. General information

NPI: 1740093053
Provider Name (Legal Business Name): TAYLOR WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5547 N RAVENSWOOD AVE
CHICAGO IL
60640-1125
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 773-570-2829
  • Fax:
Mailing address:
  • Phone: 224-306-1879
  • Fax: 224-306-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178022360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: