Individual
TYLER TAYSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 706-5000
Mailing address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8871199
ID
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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