Provider Demographics
NPI:1548733850
Name:TAYLOR-WALKER, JONATHA
Entity Type:Individual
Prefix:
First Name:JONATHA
Middle Name:
Last Name:TAYLOR-WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JONATHA
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:490 CROSS KEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3506
Mailing Address - Country:US
Mailing Address - Phone:585-236-4420
Mailing Address - Fax:
Practice Address - Street 1:490 CROSS KEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3506
Practice Address - Country:US
Practice Address - Phone:585-236-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089236-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty