Individual
ANGELA S. GILL-TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
1312 E LARK ST, SPRINGFIELD, MO 65804-7351
(417) 820-3707
(417) 820-7954
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(855) 420-7900
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2003030076
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
499115608
—
MO
01
—
82773
AR BLUE SHIELD #
MO
Enumeration date
02/16/2007
Last updated
01/12/2017
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