Provider Demographics
NPI:1447923149
Name:EDMONDSON, TAYLOR DAWN (BS)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:DAWN
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33714 SE PEORIA RD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2320
Mailing Address - Country:US
Mailing Address - Phone:503-421-6517
Mailing Address - Fax:
Practice Address - Street 1:33714 SE PEORIA RD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2320
Practice Address - Country:US
Practice Address - Phone:503-421-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health