Provider Demographics
NPI:1104660349
Name:EASTWOOD, TAYLOR JOLENE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JOLENE
Last Name:EASTWOOD
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 1:1019 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3306
Mailing Address - Country:US
Mailing Address - Phone:309-339-7651
Mailing Address - Fax:
Practice Address - Street 1:1709 JUMER DR STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-0914
Practice Address - Country:US
Practice Address - Phone:309-431-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor