Provider Demographics
NPI:1639821671
Name:TAYLOR, JASMYN ANITA CHARMICE (MSW, LGSW)
Entity Type:Individual
Prefix:MISS
First Name:JASMYN
Middle Name:ANITA CHARMICE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 GROVE DR # 300
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4400
Mailing Address - Country:US
Mailing Address - Phone:763-328-6326
Mailing Address - Fax:
Practice Address - Street 1:2120 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3378
Practice Address - Country:US
Practice Address - Phone:763-328-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN293421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical