Provider Demographics
NPI:1407159098
Name:GRONECK, TAYLOR S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:S
Last Name:GRONECK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2921
Mailing Address - Country:US
Mailing Address - Phone:859-992-1615
Mailing Address - Fax:859-359-5406
Practice Address - Street 1:925 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2921
Practice Address - Country:US
Practice Address - Phone:859-992-1615
Practice Address - Fax:859-359-5406
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical