Provider Demographics
NPI:1619586997
Name:BUFTON, TAYLOR A (APSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:BUFTON
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1526
Mailing Address - Country:US
Mailing Address - Phone:262-637-8888
Mailing Address - Fax:262-637-0695
Practice Address - Street 1:717 N EAST AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4806
Practice Address - Country:US
Practice Address - Phone:262-547-2463
Practice Address - Fax:262-547-8002
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131907-121104100000X
WI11019-123104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11019-123OtherLCSW
WI131907-121OtherAPSW-IT