Provider Demographics
NPI:1497854277
Name:TAYLOR, KIM MICHAEL (MSW)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8296 BRIDLE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-2530
Mailing Address - Country:US
Mailing Address - Phone:513-321-0500
Mailing Address - Fax:513-474-0807
Practice Address - Street 1:1015 DELTA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-3103
Practice Address - Country:US
Practice Address - Phone:513-321-0500
Practice Address - Fax:513-474-0807
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00003501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical