Provider Demographics
NPI:1477067486
Name:TAYLOR, HOLLY D
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:D
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:1999 N AMIDON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2122
Mailing Address - Country:US
Mailing Address - Phone:316-768-6718
Mailing Address - Fax:
Practice Address - Street 1:1999 N AMIDON AVE STE 110
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2122
Practice Address - Country:US
Practice Address - Phone:316-768-6718
Practice Address - Fax:316-768-6718
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist