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General NPI Number Information
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NPI Number | 1073233540
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Entity Type | Individual
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Provider Name | KAITLYN TAYLOR RUNYON PLMHP PCMSW
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Gender | Female
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 15705 W DODGE RD SUITE 102
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City | OMAHA
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State | NE
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Zip | 68118
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Country | US
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Telephone | 402-575-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 10899 POLK ST
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City | OMAHA
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State | NE
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Zip | 68137-4700
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Country | US
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Telephone | 402-968-2816
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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 | 12637
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License Number State | NE
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