Provider Demographics
NPI:1487212411
Name:AYLOR, ADRIAN (AUD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:AYLOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TOWER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5011
Mailing Address - Country:US
Mailing Address - Phone:605-217-4320
Mailing Address - Fax:605-217-2948
Practice Address - Street 1:101 TOWER RD STE 120
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5011
Practice Address - Country:US
Practice Address - Phone:605-217-4320
Practice Address - Fax:605-217-2948
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1023231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1114141546Medicaid