Provider Demographics
NPI:1891947149
Name:TAYLOR, JERILYN ANN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JERILYN
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4473 220TH AVE.
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677
Mailing Address - Country:US
Mailing Address - Phone:231-832-2247
Mailing Address - Fax:231-832-3281
Practice Address - Street 1:4473 220TH AVE.
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677
Practice Address - Country:US
Practice Address - Phone:231-832-2247
Practice Address - Fax:231-832-3281
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010890481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical