Provider Demographics
NPI:1417492364
Name:TAYLOR, KATELYN CHRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:CHRISTINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:CHRISTINE
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1503 AZTEC TRCE
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2362
Mailing Address - Country:US
Mailing Address - Phone:661-304-8258
Mailing Address - Fax:
Practice Address - Street 1:1503 AZTEC TRCE
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2362
Practice Address - Country:US
Practice Address - Phone:661-304-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010445235Z00000X
TX112265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty