Provider Demographics
NPI:1225095508
Name:TAYLOR, KIRSTEN L (LPC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:L
Other - Last Name:GOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KIRSTEN T ZECH
Mailing Address - Street 1:1401 PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-9709
Mailing Address - Country:US
Mailing Address - Phone:715-379-9408
Mailing Address - Fax:
Practice Address - Street 1:1401 PETERSON AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-9709
Practice Address - Country:US
Practice Address - Phone:715-379-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3628125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41002800Medicaid
WI59425OtherSECURITY HEALTH PLAN
MN637871045410OtherPREFERRED ONE
MNHP58073OtherHEALTH PARTNERS
MN80G42THOtherBCBS MN