Provider Demographics
NPI:1083738447
Name:TAYLOR, ELIZABETH GAMBLE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GAMBLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:5108 VINCENT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2249
Mailing Address - Country:US
Mailing Address - Phone:612-889-5250
Mailing Address - Fax:
Practice Address - Street 1:8401 WAYZATA BLVD STE 370
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1379
Practice Address - Country:US
Practice Address - Phone:763-544-1006
Practice Address - Fax:763-544-1008
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN158971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical