Provider Demographics
NPI:1528405560
Name:PENA, TAYLOR KNOTTS
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KNOTTS
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4431
Mailing Address - Country:US
Mailing Address - Phone:404-849-6075
Mailing Address - Fax:
Practice Address - Street 1:1144 MARTIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4431
Practice Address - Country:US
Practice Address - Phone:404-849-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist