Provider Demographics
NPI:1477177376
Name:TAYLOR, EMILY M (MA, SLP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 BELLE ISLE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-5675
Mailing Address - Country:US
Mailing Address - Phone:217-891-1478
Mailing Address - Fax:
Practice Address - Street 1:1309 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2526
Practice Address - Country:US
Practice Address - Phone:815-214-9066
Practice Address - Fax:855-674-0099
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4367289OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION