Healthcare Provider Details

I. General information

NPI: 1013734722
Provider Name (Legal Business Name): ALLISON LYNN TAYLOR EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST
MUNCIE IN
47305-2046
US

IV. Provider business mailing address

1305 N SWISS DR
MUNCIE IN
47304-5050
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-5434
  • Fax:
Mailing address:
  • Phone: 317-908-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10322354
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: