Provider Demographics
NPI:1750177069
Name:TAYLOR, DAWN (PPS, LEP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:
Credentials:PPS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9345 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2129
Mailing Address - Country:US
Mailing Address - Phone:909-214-9624
Mailing Address - Fax:
Practice Address - Street 1:500 N LORAINE AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2964
Practice Address - Country:US
Practice Address - Phone:626-852-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250088212103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool