MEDICARE: TAYLOR FERGUSON-WADE

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

General Provider Information

NPI Number	:	1811743388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR FERGUSON-WADE

Provider Business Mailing Address
First Line	:	2470 SAINT ROSE PKWY STE 101
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7773
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2470 SAINT ROSE PKWY STE 101
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7773
Country	:	US
Telephone Number	:	702-808-8141
Fax Number	:

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

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	04/25/2024

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