Provider Demographics
NPI:1578903084
Name:TAYLOR- GREEN, KATRINA (M ED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:TAYLOR- GREEN
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1214
Mailing Address - Country:US
Mailing Address - Phone:682-422-7952
Mailing Address - Fax:
Practice Address - Street 1:7240 CANA
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054
Practice Address - Country:US
Practice Address - Phone:225-205-1879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist