MEDICARE: MRS. TAYLOR TYNDALL MSW, LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.1201161	OH

General Provider Information

NPI Number	:	1023555406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAYLOR TYNDALL MSW, LSW

Provider Business Mailing Address
First Line	:	650 GRAHAM RD
Second Line	:	SUITE 101
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-1052
Country	:	US
Telephone Number	:	330-928-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 E MAIN ST
Second Line	:	SUITE 103
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2580
Country	:	US
Telephone Number	:	330-573-7686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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