Healthcare Provider Details

I. General information

NPI: 1720993637
Provider Name (Legal Business Name): MADISYN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 OHIO PIKE STE 102
CINCINNATI OH
45255-3746
US

IV. Provider business mailing address

3704 DECOURSEY AVE
COVINGTON KY
41015-1486
US

V. Phone/Fax

Practice location:
  • Phone: 151-393-9030
  • Fax:
Mailing address:
  • Phone: 270-799-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: