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General NPI Number Information
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NPI Number | 1033820600
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Entity Type | Individual
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Provider Name | TEYLOR ISOME
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 119 BINGHAM DR
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City | BROOKLYN
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State | MI
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Zip | 49230-8926
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Country | US
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Telephone | 513-693-0191
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Fax |
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Provider Business Mailing Address
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Address Line | 2728 WESTMAR CT APT 506
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City | TOLEDO
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State | OH
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Zip | 43615-2093
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Country | US
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Telephone | 513-693-0191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851114632
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License Number State | MI
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