Provider Demographics
NPI:1356573216
Name:VAN NORDEN, TAYLEENE MARIE
Entity type:Individual
Prefix:
First Name:TAYLEENE
Middle Name:MARIE
Last Name:VAN NORDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLEENE
Other - Middle Name:MARIE
Other - Last Name:GAYLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-3049
Mailing Address - Country:US
Mailing Address - Phone:620-285-6041
Mailing Address - Fax:620-285-6194
Practice Address - Street 1:612 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-3049
Practice Address - Country:US
Practice Address - Phone:620-285-6041
Practice Address - Fax:620-285-6194
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4566104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker