Provider Demographics
NPI:1760102891
Name:TAYLOR, ALEXIS KAELIN (LGSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KAELIN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:KAELIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:930 FARM LINE RD APT 308
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-9768
Mailing Address - Country:US
Mailing Address - Phone:612-616-0785
Mailing Address - Fax:
Practice Address - Street 1:930 FARM LINE RD APT 308
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-9768
Practice Address - Country:US
Practice Address - Phone:612-616-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2023-12-15
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