Provider Demographics
NPI:1023555406
Name:TYNDALL, TAYLOR (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 GRAHAM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1052
Mailing Address - Country:US
Mailing Address - Phone:330-928-0044
Mailing Address - Fax:
Practice Address - Street 1:5300 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2580
Practice Address - Country:US
Practice Address - Phone:330-573-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1201161104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker