Provider Demographics
NPI:1194357624
Name:TURNER, TAYLOR JUDITH
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JUDITH
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JUDITH
Other - Last Name:PROSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10097 MANCHESTER RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1828
Mailing Address - Country:US
Mailing Address - Phone:314-394-1911
Mailing Address - Fax:314-735-4165
Practice Address - Street 1:12255 DE PAUL DR STE 860
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2515
Practice Address - Country:US
Practice Address - Phone:314-394-1911
Practice Address - Fax:314-735-4165
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2021020504231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program