Provider Demographics
NPI:1033343926
Name:TAYLOR, KEITH D
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 LARSDOTTER LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4499
Mailing Address - Country:US
Mailing Address - Phone:847-894-0709
Mailing Address - Fax:
Practice Address - Street 1:1712 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2037
Practice Address - Country:US
Practice Address - Phone:815-758-0157
Practice Address - Fax:815-758-0375
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1709237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist