Provider Demographics
NPI:1134662158
Name:TAYLOR, SHAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1820
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7401
Mailing Address - Country:US
Mailing Address - Phone:312-372-4926
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1820
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:312-372-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical