Provider Demographics
NPI:1871709600
Name:TAYLOR SCHULTZ, JAN ELLEN
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:ELLEN
Last Name:TAYLOR SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:ELLEN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3925 HAGAN STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:49401
Mailing Address - Country:US
Mailing Address - Phone:812-334-0001
Mailing Address - Fax:
Practice Address - Street 1:3925 HAGAN STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:49401
Practice Address - Country:US
Practice Address - Phone:812-334-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003957A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker