Healthcare Provider Details

I. General information

NPI: 1528447661
Provider Name (Legal Business Name): SYMONE-D'AURI JORDAN TAYLOR M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 SW AVALON WAY APT 602
SEATTLE WA
98126-2890
US

IV. Provider business mailing address

PO BOX 16113
SEATTLE WA
98116-0113
US

V. Phone/Fax

Practice location:
  • Phone: 253-254-6708
  • Fax:
Mailing address:
  • Phone:
  • Fax: 727-327-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW 9336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: