Provider Demographics
NPI:1396571683
Name:FRIEDLI, TAYLOR NICOLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:FRIEDLI
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 1:1461 E CAMINO ALTO ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7336
Mailing Address - Country:US
Mailing Address - Phone:573-682-7150
Mailing Address - Fax:
Practice Address - Street 1:2025 E CHESTNUT EXPY STE J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6507
Practice Address - Country:US
Practice Address - Phone:417-848-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230330171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical