Healthcare Provider Details

I. General information

NPI: 1487371332
Provider Name (Legal Business Name): TAYLOR JO JOHNSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR JO STECKELBERG

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SIBLEY ST
MANKATO MN
56001-2056
US

IV. Provider business mailing address

690 7TH ST SW
WELLS MN
56097-1202
US

V. Phone/Fax

Practice location:
  • Phone: 507-484-2400
  • Fax:
Mailing address:
  • Phone: 507-525-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27851
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: