Provider Demographics
NPI:1235521808
Name:TAYLOR, KELLEY (MSW, CDP, LICSWA)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW, CDP, LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2802
Mailing Address - Country:US
Mailing Address - Phone:509-326-7740
Mailing Address - Fax:509-326-6725
Practice Address - Street 1:1224 N ASH ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2802
Practice Address - Country:US
Practice Address - Phone:509-326-7740
Practice Address - Fax:509-326-6725
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005782101YA0400X
WASC604750601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952474405Medicaid