Healthcare Provider Details

I. General information

NPI: 1427245950
Provider Name (Legal Business Name): JEANNINE TAYLOR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 N CEDAR ST
MASON MI
48854-1015
US

IV. Provider business mailing address

566 N CEDAR ST
MASON MI
48854-1015
US

V. Phone/Fax

Practice location:
  • Phone: 517-676-2461
  • Fax: 517-676-2158
Mailing address:
  • Phone: 517-676-2461
  • Fax: 517-676-2158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801063438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: