Provider Demographics
NPI:1184951691
Name:TAYLOR-GERKEN, POLLY A (M ED, EDS, SP)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:A
Last Name:TAYLOR-GERKEN
Suffix:
Gender:F
Credentials:M ED, EDS, SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4346
Mailing Address - Country:US
Mailing Address - Phone:419-380-0016
Mailing Address - Fax:419-380-0016
Practice Address - Street 1:3445 RIVER RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-4346
Practice Address - Country:US
Practice Address - Phone:419-380-0016
Practice Address - Fax:419-380-0016
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP564103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool