Provider Demographics
NPI:1083353783
Name:BINVERSIE, TAYLOR R (MS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:R
Last Name:BINVERSIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7169 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-9403
Mailing Address - Country:US
Mailing Address - Phone:920-887-7545
Mailing Address - Fax:
Practice Address - Street 1:502 S HIGH POINT RD STE 150
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4947
Practice Address - Country:US
Practice Address - Phone:920-887-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14393537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist