Provider Demographics
NPI:1235805581
Name:MCINTIRE, TAYLOR ALISE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALISE
Last Name:MCINTIRE
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 1:333 E MCKINLEY ST APT 604
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1171
Mailing Address - Country:US
Mailing Address - Phone:419-490-4750
Mailing Address - Fax:
Practice Address - Street 1:13575 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2604
Practice Address - Country:US
Practice Address - Phone:623-536-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
AZTSLP13301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist