Individual
MISTY DAWN TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS/MHP
Contact information
Practice address
1801 FOX DR, CHAMPAIGN, IL 61820-7236
(217) 693-4560
(121) 739-8017
Mailing address
1801 FOX DR, CHAMPAIGN, IL 61820-7236
(217) 693-4560
(121) 739-8017
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
T46054482630
IL
Other
Enumeration date
07/07/2008
Last updated
07/07/2008
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