Healthcare Provider Details

I. General information

NPI: 1699579870
Provider Name (Legal Business Name): TAYLOR MARIE BIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SHERMAN ST
SAINT PAUL MN
55102-2564
US

IV. Provider business mailing address

241 DAYTON AVE APT 3
SAINT PAUL MN
55102-3398
US

V. Phone/Fax

Practice location:
  • Phone: 651-383-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4945
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: