Provider Demographics
NPI:1124597141
Name:TAYLOR, ANNE REGINA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:REGINA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:REGINA
Other - Last Name:PULASKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:912 REGENT CT
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9773
Mailing Address - Country:US
Mailing Address - Phone:720-771-7905
Mailing Address - Fax:
Practice Address - Street 1:172 N PARK ST
Practice Address - Street 2:
Practice Address - City:PELLSTON
Practice Address - State:MI
Practice Address - Zip Code:49769-9400
Practice Address - Country:US
Practice Address - Phone:231-539-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010944811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical