Provider Demographics
NPI:1922663251
Name:LINDWEDEL, TAYLOR MARIE (MA, PLPC, NCC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:LINDWEDEL
Suffix:
Gender:F
Credentials:MA, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 PARTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1943
Mailing Address - Country:US
Mailing Address - Phone:314-854-5768
Mailing Address - Fax:314-854-5751
Practice Address - Street 1:1340 PARTRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-1943
Practice Address - Country:US
Practice Address - Phone:314-854-5768
Practice Address - Fax:314-854-5751
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019013411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019013411Medicaid