MEDICARE: AMY JOANN TAYLOR LMSW

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	101YM0800X	Mental Health Counselor	6801077319	MI
2	1041C0700X	Clinical Social Worker	6801077319	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AT077319	OTHER	MI	3RD PARTY IDENTIFIER
2	6801086768	OTHER	MI	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1932170503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JOANN TAYLOR LMSW

Provider Business Mailing Address
First Line	:	3782 MOMENTUM PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5337
Country	:	US
Telephone Number	:	231-876-7234
Fax Number	:

Provider Business Practice Location Address
First Line	:	7985 MACKINAW TRL
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-8111
Country	:	US
Telephone Number	:	231-876-6200
Fax Number	:	231-876-6299

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	02/06/2017

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Directions to “ AMY JOANN TAYLOR LMSW” Practice Location

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