Provider Demographics
NPI:1497113161
Name:STEWART, TAYLOR ELYSE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELYSE
Last Name:STEWART
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 1:195 N GRANT AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2855
Mailing Address - Country:US
Mailing Address - Phone:614-203-2361
Mailing Address - Fax:614-928-9092
Practice Address - Street 1:195 N GRANT AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2855
Practice Address - Country:US
Practice Address - Phone:614-203-2361
Practice Address - Fax:614-928-9092
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL.1501279104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker