Provider Demographics
NPI:1043395924
Name:TAYLOR, DAWN O (CP)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:O
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 PENROSE PL STE 250
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1877
Mailing Address - Country:US
Mailing Address - Phone:303-473-4435
Mailing Address - Fax:303-447-6453
Practice Address - Street 1:3445 PENROSE PL STE 250
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1877
Practice Address - Country:US
Practice Address - Phone:303-473-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07007313Medicaid
COC88966Medicare PIN