Provider Demographics
NPI:1760102891
Name:TAYLOR, ALEXIS KAELIN (LICSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KAELIN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:KAELIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:330 S SECOND AVE SUITE 200 #1151
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12400 PORTLAND AVE STE 180
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6875
Practice Address - Country:US
Practice Address - Phone:952-222-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2025-06-27
Deactivation Date:2023-01-06
Deactivation Code:
Reactivation Date:2023-12-15
Provider Licenses
StateLicense IDTaxonomies
MN299551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical