Provider Demographics
NPI:1467977280
Name:EATON, TAYLOR RAE (MCD, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:RAE
Last Name:EATON
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3148
Mailing Address - Country:US
Mailing Address - Phone:870-400-0179
Mailing Address - Fax:
Practice Address - Street 1:610 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3148
Practice Address - Country:US
Practice Address - Phone:870-400-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200946OtherABESPA