Healthcare Provider Details

I. General information

NPI: 1821463910
Provider Name (Legal Business Name): TAYLOR MOKMA LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E LIVINGSTON AVE
COLUMBUS OH
43205-2618
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-8200
  • Fax: 614-722-4046
Mailing address:
  • Phone: 614-722-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1600376
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.1400141TRNE
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1801051
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: