Provider Demographics
NPI:1508955063
Name:TAYLOR, LAURA (CCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 LAFITE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-9808
Mailing Address - Country:US
Mailing Address - Phone:501-351-2301
Mailing Address - Fax:501-325-0678
Practice Address - Street 1:1389 LAFITE LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-9808
Practice Address - Country:US
Practice Address - Phone:501-351-2301
Practice Address - Fax:501-325-0678
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist