Provider Demographics
NPI:1811574841
Name:SCHOUMAKER, TAYLOR RENEE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:SCHOUMAKER
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 1:2644 240TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOK PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55007-4656
Mailing Address - Country:US
Mailing Address - Phone:612-481-1545
Mailing Address - Fax:
Practice Address - Street 1:2644 240TH AVE
Practice Address - Street 2:
Practice Address - City:BROOK PARK
Practice Address - State:MN
Practice Address - Zip Code:55007-4656
Practice Address - Country:US
Practice Address - Phone:612-481-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1106681253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency