Provider Demographics
NPI:1164196739
Name:TAYLOR, BREANNA L
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19400 E 37TH TERRACE CT S APT 301
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2486
Mailing Address - Country:US
Mailing Address - Phone:574-242-2505
Mailing Address - Fax:
Practice Address - Street 1:19400 E 37TH TERRACE CT S APT 301
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2486
Practice Address - Country:US
Practice Address - Phone:574-242-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist