Provider Demographics
NPI:1053478198
Name:BRENDA A. TAYLOR
Entity Type:Organization
Organization Name:BRENDA A. TAYLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:SPEECH PATHOLOGIST
Authorized Official - Phone:919-734-6649
Mailing Address - Street 1:627 DEER ACRES DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9238
Mailing Address - Country:US
Mailing Address - Phone:919-734-6649
Mailing Address - Fax:919-734-6649
Practice Address - Street 1:627 DEER ACRES DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9238
Practice Address - Country:US
Practice Address - Phone:919-734-6649
Practice Address - Fax:919-734-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211396Medicaid