Provider Demographics
NPI:1669712956
Name:TAYLOR, JAQUELINE SHEANNETTE
Entity type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:SHEANNETTE
Last Name:TAYLOR
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 1:6145 CIRCLING HAWK DR
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1656
Mailing Address - Country:US
Mailing Address - Phone:702-236-5232
Mailing Address - Fax:702-657-0248
Practice Address - Street 1:6145 CIRCLING HAWK DR
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1656
Practice Address - Country:US
Practice Address - Phone:702-236-5232
Practice Address - Fax:702-657-0248
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral