Provider Demographics
NPI:1497046338
Name:NEWENDORP, TAYLOR (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:
Last Name:NEWENDORP
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 N CICERO AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4312
Mailing Address - Country:US
Mailing Address - Phone:773-932-9597
Mailing Address - Fax:
Practice Address - Street 1:6160 N CICERO AVE STE 630
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4325
Practice Address - Country:US
Practice Address - Phone:773-932-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007274101Y00000X
IL180.007907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor