Provider Demographics
NPI:1699542753
Name:DEW, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:DEW
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:DEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3955 GRAND HAVEN RD APT 104C
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5157
Mailing Address - Country:US
Mailing Address - Phone:231-215-4464
Mailing Address - Fax:
Practice Address - Street 1:3955 GRAND HAVEN RD APT 104C
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5157
Practice Address - Country:US
Practice Address - Phone:231-215-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician