Provider Demographics
NPI:1649050253
Name:POWELSON, TAYLOR JEAN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JEAN
Last Name:POWELSON
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 1:299 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELPER
Mailing Address - State:UT
Mailing Address - Zip Code:84526-1163
Mailing Address - Country:US
Mailing Address - Phone:801-232-8279
Mailing Address - Fax:
Practice Address - Street 1:299 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HELPER
Practice Address - State:UT
Practice Address - Zip Code:84526-1163
Practice Address - Country:US
Practice Address - Phone:801-232-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach