Provider Demographics
NPI:1720590581
Name:LAIRD, TAYLOR JO
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JO
Last Name:LAIRD
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 1:1368 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MI
Mailing Address - Zip Code:49328-9623
Mailing Address - Country:US
Mailing Address - Phone:616-320-7476
Mailing Address - Fax:
Practice Address - Street 1:1368 122ND AVE
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MI
Practice Address - Zip Code:49328-9623
Practice Address - Country:US
Practice Address - Phone:616-320-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician