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General NPI Number Information
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NPI Number | 1154607166
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Entity Type | Individual
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Provider Name | BYRON KEITH TAYLOR LSW
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Gender | Male
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 820 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3728
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Country | US
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Telephone | 312-569-7465
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Fax | 312-569-6105
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Provider Business Mailing Address
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Address Line | 5528 S INDIANA AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60637-1025
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Country | US
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Telephone | 708-717-9684
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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 | 150013104
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License Number State | IL
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