Provider Demographics
NPI:1659708857
Name:TEMPLE, TAYLOR RAE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 CAHILL MAIN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7130
Mailing Address - Country:US
Mailing Address - Phone:608-819-6810
Mailing Address - Fax:608-819-6811
Practice Address - Street 1:2990 CAHILL MAIN
Practice Address - Street 2:SUITE 204
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7130
Practice Address - Country:US
Practice Address - Phone:608-819-6810
Practice Address - Fax:608-819-6811
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI220-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst