Provider Demographics
NPI:1669862777
Name:TAYLOR, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:TAYLOR
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:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-0450
Mailing Address - Country:US
Mailing Address - Phone:503-769-7403
Mailing Address - Fax:
Practice Address - Street 1:14262 WEJOCUMA LN SE
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:OR
Practice Address - Zip Code:97392-9747
Practice Address - Country:US
Practice Address - Phone:503-769-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist