Provider Demographics
NPI:1558727826
Name:WITT, TAYLOR LEIGH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:LEIGH
Last Name:WITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31480 N US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9444
Mailing Address - Country:US
Mailing Address - Phone:847-680-2715
Mailing Address - Fax:
Practice Address - Street 1:31480 N US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9444
Practice Address - Country:US
Practice Address - Phone:847-680-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0172111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical