Provider Demographics
NPI:1558025817
Name:TAYLOR, ERIN NICOLE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S KITCHELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-1500
Mailing Address - Country:US
Mailing Address - Phone:618-308-2845
Mailing Address - Fax:
Practice Address - Street 1:302 S KITCHELL AVE STE B
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-1500
Practice Address - Country:US
Practice Address - Phone:618-354-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009560A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical