Provider Demographics
NPI:1033560404
Name:BOYD, TAYLOR NOLAN (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:NOLAN
Last Name:BOYD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:NOLAN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 BOND AVE NW UNIT 803
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1493
Mailing Address - Country:US
Mailing Address - Phone:231-557-4277
Mailing Address - Fax:
Practice Address - Street 1:400 ANN ST NE STE 106A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505
Practice Address - Country:US
Practice Address - Phone:616-591-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist