Provider Demographics
NPI:1467144212
Name:DEWEES, TAYLOR RENEE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:DEWEES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W252N9140 TOMAHAWK CT
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53089-1018
Mailing Address - Country:US
Mailing Address - Phone:262-229-5715
Mailing Address - Fax:
Practice Address - Street 1:W252N9140 TOMAHAWK CT
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:WI
Practice Address - Zip Code:53089-1018
Practice Address - Country:US
Practice Address - Phone:262-229-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker