Provider Demographics
NPI:1558036251
Name:SMITH, TAYLOR (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ST. MARY'S EPWORTH CROSSING
Mailing Address - Street 2:SUITE A602
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630
Mailing Address - Country:US
Mailing Address - Phone:812-469-8175
Mailing Address - Fax:
Practice Address - Street 1:100 ST. MARY'S EPWORTH CROSSING
Practice Address - Street 2:SUITE A602
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-469-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
IN74000447A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS