Provider Demographics
NPI:1508331067
Name:TAYLOR, KAROLYN TARA
Entity Type:Individual
Prefix:
First Name:KAROLYN
Middle Name:TARA
Last Name:TAYLOR
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:N94W15802 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-1534
Mailing Address - Country:US
Mailing Address - Phone:414-975-9867
Mailing Address - Fax:
Practice Address - Street 1:N94W15802 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-1534
Practice Address - Country:US
Practice Address - Phone:414-975-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8723101YP2500X
WI605592101YS0200X
WI4136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4136OtherLICENSE