Provider Demographics
NPI:1386356681
Name:ROHOW, TAYLOR ROSE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ROSE
Last Name:ROHOW
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 1:4140 RICHARD AVE STE 200&300
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2869
Mailing Address - Country:US
Mailing Address - Phone:218-514-5230
Mailing Address - Fax:
Practice Address - Street 1:4140 RICHARD AVE STE 200&300
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-2869
Practice Address - Country:US
Practice Address - Phone:218-514-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician