MEDICARE: TAYLOR LEVITT

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	103TC0700X	Clinical Psychologist	071.011221	IL

General Provider Information

NPI Number	:	1124690862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LEVITT

Provider Business Mailing Address
First Line	:	2580 FOXFIELD RD STE 101
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-1403
Country	:	US
Telephone Number	:	630-797-9332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 FOXFIELD RD STE 101
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-1403
Country	:	US
Telephone Number	:	630-797-9332
Fax Number	:

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

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	09/04/2024

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Directions to “ TAYLOR LEVITT ” Practice Location

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