Provider Demographics
NPI:1194707794
Name:TAYLOR, NORMA J (PSYD)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:J
Other - Last Name:THORP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:600 25TH AVE S
Mailing Address - Street 2:STE 109
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4841
Mailing Address - Country:US
Mailing Address - Phone:320-255-0343
Mailing Address - Fax:320-654-0318
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:STE 109
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4841
Practice Address - Country:US
Practice Address - Phone:320-255-0343
Practice Address - Fax:320-654-0318
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN084850600Medicaid
191033OtherMAYO MANAGEMENT
76D27TAOtherBLUE CROSS BLUE PLUS
6112115OtherUBH MEDICA SELECT CARE
MN084850600Medicaid