Individual
LARRY E TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10532 N PORT WASHINGTON RD, MEQUON, WI 53092-5563
(262) 242-3810
(262) 242-3816
Mailing address
PO BOX 241141, MILWAUKEE, WI 53224-9027
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
16901-130
WI
Other
Enumeration date
12/24/2013
Last updated
12/24/2013
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