Healthcare Provider Details

I. General information

NPI: 1336544675
Provider Name (Legal Business Name): MEGAN GRACE TAYLOR M.S., P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 STATE ROAD 70
WEBSTER WI
54893-9251
US

IV. Provider business mailing address

4404 STATE ROAD 70
WEBSTER WI
54893-9251
US

V. Phone/Fax

Practice location:
  • Phone: 715-349-2195
  • Fax: 715-349-8528
Mailing address:
  • Phone: 715-349-2195
  • Fax: 715-349-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2295-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: