Provider Demographics
NPI:1326748534
Name:EVANS, TAYLOR LEE (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4381
Mailing Address - Country:US
Mailing Address - Phone:770-645-1900
Mailing Address - Fax:
Practice Address - Street 1:75 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4381
Practice Address - Country:US
Practice Address - Phone:770-645-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist