Provider Demographics
NPI:1033857958
Name:TAYLOR, PENNY L (MDIV, MSW, PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MDIV, MSW, PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1630
Mailing Address - Country:US
Mailing Address - Phone:708-387-7986
Mailing Address - Fax:
Practice Address - Street 1:3604 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1630
Practice Address - Country:US
Practice Address - Phone:708-387-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0138531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical