Provider Demographics
NPI:1225606213
Name:HOOGEVEEN, TAYLER LARAYE (MSW, CSW, LGSW)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:LARAYE
Last Name:HOOGEVEEN
Suffix:
Gender:F
Credentials:MSW, CSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 S GRAYSTONE AVE APT 232
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8736
Mailing Address - Country:US
Mailing Address - Phone:507-227-5266
Mailing Address - Fax:
Practice Address - Street 1:6810 S LYNCREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2515
Practice Address - Country:US
Practice Address - Phone:605-496-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29875104100000X
SD5253104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker