Provider Demographics
NPI:1790395077
Name:TAYLOR, MARY EILEEN (LMSW, APSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:EILEEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53804-0503
Mailing Address - Country:US
Mailing Address - Phone:563-599-9140
Mailing Address - Fax:
Practice Address - Street 1:530 S WATER ST STE 3
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3626
Practice Address - Country:US
Practice Address - Phone:608-348-5088
Practice Address - Fax:608-348-3302
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100996104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker