Provider Demographics
NPI:1336599778
Name:PRUETT, TAYLOR (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:
Last Name:PRUETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E SOUTH WATER ST
Mailing Address - Street 2:APT. 1206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4028
Mailing Address - Country:US
Mailing Address - Phone:317-370-1426
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1925
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-283-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0180321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical