Provider Demographics
NPI:1699114611
Name:TAYLOR, KYLIE A (LPC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KESSEL CT STE 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:608-745-9292
Mailing Address - Fax:608-745-9293
Practice Address - Street 1:322 DEWITT ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2114
Practice Address - Country:US
Practice Address - Phone:608-745-9292
Practice Address - Fax:608-745-9293
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5725-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1699114611Medicaid