Provider Demographics
NPI:1619699196
Name:VAN ALLEN, TAYLOR (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:VAN ALLEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:PO BOX 3032
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-3032
Mailing Address - Country:US
Mailing Address - Phone:507-344-3360
Mailing Address - Fax:
Practice Address - Street 1:2100 BASSETT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6888
Practice Address - Country:US
Practice Address - Phone:612-240-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN284081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical