Healthcare Provider Details

I. General information

NPI: 1245610591
Provider Name (Legal Business Name): TAYLOR DILLON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR MONTANA & SMITH

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 02/12/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 MAIN ST
HURON OH
44839-1610
US

IV. Provider business mailing address

348 MAIN ST
HURON OH
44839-1610
US

V. Phone/Fax

Practice location:
  • Phone: 419-366-3533
  • Fax:
Mailing address:
  • Phone: 419-366-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1440457
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1801039
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: