Provider Demographics
NPI:1275634669
Name:TAYLOR, STEPHEN F (MA LP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-1537
Mailing Address - Country:US
Mailing Address - Phone:218-744-4040
Mailing Address - Fax:218-744-4202
Practice Address - Street 1:8062 HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-4116
Practice Address - Country:US
Practice Address - Phone:218-744-4040
Practice Address - Fax:218-744-4202
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2571103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN256552800Medicaid