MEDICARE: MS. TAYLER MARIE KELLY L'AMOUREUX LICSW

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	1041C0700X	Clinical Social Worker	23507	MN

General Provider Information

NPI Number	:	1427599505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAYLER MARIE KELLY L'AMOUREUX LICSW

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 NICOLLET AVE STE 210
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3747
Country	:	US
Telephone Number	:	612-442-3620
Fax Number	:

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

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	07/21/2022

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