Provider Demographics
NPI:1043395924
Name:TAYLOR, DAWN O (CP)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:O
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3445 PENROSE PL STE 250
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1877
Mailing Address - Country:US
Mailing Address - Phone:303-473-4435
Mailing Address - Fax:303-447-6453
Practice Address - Street 1:3445 PENROSE PL
Practice Address - Street 2:SUITE 250
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1878
Practice Address - Country:US
Practice Address - Phone:303-473-4435
Practice Address - Fax:303-447-6453
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO731103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07007313Medicaid
COC88966Medicare PIN