Provider Demographics
NPI:1902443948
Name:KUSIC, TAYLOR A (LSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:KUSIC
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:A
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:541 STATE ROUTE 664 N STE C
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8541
Practice Address - Country:US
Practice Address - Phone:740-385-6594
Practice Address - Fax:740-774-6617
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker