Healthcare Provider Details

I. General information

NPI: 1477176725
Provider Name (Legal Business Name): TAYLOR LEIGH RIECK MSW, LISW-S, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR LEIGH BRAY MSW, LISW-S, LCSW

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 VALLEY ST
DAYTON OH
45404-2066
US

IV. Provider business mailing address

860 VALLEY ST
DAYTON OH
45404-2066
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3000
  • Fax:
Mailing address:
  • Phone: 937-641-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2406158-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: