Provider Demographics
NPI:1942642756
Name:TAYLOR, JESSICA LYNN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
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 1:1300 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7214
Mailing Address - Country:US
Mailing Address - Phone:800-949-1005
Mailing Address - Fax:928-226-7128
Practice Address - Street 1:1300 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7214
Practice Address - Country:US
Practice Address - Phone:800-949-1005
Practice Address - Fax:928-226-7128
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-12671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker