Healthcare Provider Details

I. General information

NPI: 1679374177
Provider Name (Legal Business Name): TAYLOR ROBERSON-WILLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W CAPITOL DR
MILWAUKEE WI
53212-1185
US

IV. Provider business mailing address

6235 W CLOVERLEAF LN
BROWN DEER WI
53223-1215
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-6320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: