Healthcare Provider Details

I. General information

NPI: 1922889302
Provider Name (Legal Business Name): BIANCA JACQUELYN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S 5TH ST
GENEVA IL
60134-2111
US

IV. Provider business mailing address

623 E 38TH PL UNIT 101
CHICAGO IL
60653-1914
US

V. Phone/Fax

Practice location:
  • Phone: 847-287-0916
  • Fax:
Mailing address:
  • Phone: 773-997-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.031905
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: