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General NPI Number Information
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NPI Number | 1932922267
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Entity Type | Individual
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Provider Name | TAYLOR R EDWARDS LSW
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Gender |
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2451 N LINCOLN AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60614-2422
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Country | US
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Telephone | 630-428-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 W CHASE AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60626-2156
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Country | US
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Telephone | 309-397-5725
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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 | 150.114471
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License Number State | IL
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