Basic Information
| Provider Information | |||||||||
| NPI: | 1679965024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MSW, LCSW, CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2987 YARMOUTH GREENWAY DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537115852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086308889 | ||||||||
| FaxNumber: | 6082007268 | ||||||||
| Practice Location | |||||||||
| Address1: | 2987 YARMOUTH GREENWAY DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537115852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086308889 | ||||||||
| FaxNumber: | 6082007268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2015 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 8871-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.