Provider Demographics
NPI:1225200975
Name:TAYLOR, JILL GUNNELLS (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:GUNNELLS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 JAY ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-2429
Mailing Address - Country:US
Mailing Address - Phone:803-245-3742
Mailing Address - Fax:
Practice Address - Street 1:404 JAY ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-2429
Practice Address - Country:US
Practice Address - Phone:803-245-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA 0664Medicaid