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General NPI Number Information
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NPI Number | 1104298538
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Entity Type | Individual
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Provider Name | TAYLOR DEISHER LSW
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Gender | Female
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 3095 KETTERING BLVD
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City | MORAINE
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State | OH
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Zip | 45439-1983
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Country | US
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Telephone | 937-293-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 7819 LAUREL RIDGE DR
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City | DAYTON
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State | OH
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Zip | 45414-2582
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Country | US
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Telephone | 937-620-0965
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1500347
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License Number State | OH
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