Healthcare Provider Details

I. General information

NPI: 1609753953
Provider Name (Legal Business Name): TAYLOR SHEA MCMEEKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HAZEN ST
PAW PAW MI
49079-2008
US

IV. Provider business mailing address

31802 SWISHER ST
DOWAGIAC MI
49047-9275
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-5574
  • Fax:
Mailing address:
  • Phone: 269-462-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: