Healthcare Provider Details

I. General information

NPI: 1902563919
Provider Name (Legal Business Name): TAYLOR ROSE HERBORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date: 11/24/2021
Reactivation Date: 12/22/2021

III. Provider practice location address

1845 GRANDSTAND PL
ELGIN IL
60123-6603
US

IV. Provider business mailing address

1845 GRANDSTAND PL
ELGIN IL
60123-6603
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-0484
  • Fax:
Mailing address:
  • Phone: 847-695-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: