Provider Demographics
NPI:1326605015
Name:WALDVOGEL, TAYLER (MS LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:
Last Name:WALDVOGEL
Suffix:
Gender:F
Credentials:MS LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 2ND AVE NE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1226
Mailing Address - Country:US
Mailing Address - Phone:320-428-0744
Mailing Address - Fax:320-438-2829
Practice Address - Street 1:105 2ND AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1226
Practice Address - Country:US
Practice Address - Phone:320-428-0744
Practice Address - Fax:320-438-2829
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305440101YA0400X
MN101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)