Provider Demographics
NPI:1578437505
Name:ROBINSON, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ROBINSON
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 1:512 S OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:ASHMORE
Mailing Address - State:IL
Mailing Address - Zip Code:61912-9582
Mailing Address - Country:US
Mailing Address - Phone:618-563-4912
Mailing Address - Fax:
Practice Address - Street 1:500 W CLOVER ST
Practice Address - Street 2:
Practice Address - City:HUTSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62433-1017
Practice Address - Country:US
Practice Address - Phone:618-563-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2543025103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool