Provider Demographics
NPI:1295319416
Name:VACA, TAYLOR NICOLE
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:VACA
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 1:541 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2254
Mailing Address - Country:US
Mailing Address - Phone:847-532-4435
Mailing Address - Fax:
Practice Address - Street 1:1150 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2243
Practice Address - Country:US
Practice Address - Phone:773-413-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist