Provider Demographics
NPI:1770745069
Name:TAYLOR, JUDITH ANN (LISW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4808
Mailing Address - Country:US
Mailing Address - Phone:330-261-1001
Mailing Address - Fax:330-262-1037
Practice Address - Street 1:124 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4808
Practice Address - Country:US
Practice Address - Phone:330-261-1001
Practice Address - Fax:330-262-1037
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI98901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical