Provider Demographics
NPI:1043631807
Name:TAYLOR, SUSANNE (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 KAVANAUGH BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6321 KAVANAUGH BLVD APT 7
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-4240
Practice Address - Country:US
Practice Address - Phone:501-282-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist