Provider Demographics
NPI:1467182196
Name:RUNKLES, TAYLORE LEE (LSW)
Entity Type:Individual
Prefix:
First Name:TAYLORE
Middle Name:LEE
Last Name:RUNKLES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-2246
Mailing Address - Country:US
Mailing Address - Phone:302-448-0071
Mailing Address - Fax:
Practice Address - Street 1:2819 WILLOW STREET PIKE
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584
Practice Address - Country:US
Practice Address - Phone:717-464-1450
Practice Address - Fax:717-464-0890
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138768104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker