Individual
RUSSELL GUY TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
557 N WESTGATE AVE, JACKSONVILLE, IL 62650-1156
(217) 245-7275
(217) 245-7427
Mailing address
800 E CARPENTER ST, PO BOX 1977, SPRINGFIELD, IL 62702-5324
(217) 544-6464
(217) 757-6021
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06932018
BC/BS
IL
01
—
681484
HEALTHLINK
IL
Enumeration date
08/03/2006
Last updated
07/09/2007
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