Provider Demographics
NPI:1386202257
Name:WICKEY, TAYLOR LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:LEE
Last Name:WICKEY
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 1:811 BRICKYARD CIR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8058
Mailing Address - Country:US
Mailing Address - Phone:330-241-2760
Mailing Address - Fax:
Practice Address - Street 1:811 BRICKYARD CIR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8058
Practice Address - Country:US
Practice Address - Phone:330-241-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14320794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist