Healthcare Provider Details

I. General information

NPI: 1740084102
Provider Name (Legal Business Name): TAYLOR WHITTEN CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHGATE STE 3
PENDLETON OR
97801-3971
US

IV. Provider business mailing address

65348 GURDANE RD
PILOT ROCK OR
97868-6606
US

V. Phone/Fax

Practice location:
  • Phone: 541-215-4440
  • Fax: 541-429-4118
Mailing address:
  • Phone: 541-377-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA15483
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: