Provider Demographics
NPI:1194367417
Name:TAYLOR, DIANA LYNNE (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3011
Mailing Address - Country:US
Mailing Address - Phone:731-803-3730
Mailing Address - Fax:
Practice Address - Street 1:2075 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3011
Practice Address - Country:US
Practice Address - Phone:731-803-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty