Provider Demographics
NPI:1609413137
Name:TAYLOR, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TAYLOR
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 1:3964 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-1104
Mailing Address - Country:US
Mailing Address - Phone:850-741-6715
Mailing Address - Fax:
Practice Address - Street 1:3331 SUMMIT BLVD APT 172
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4331
Practice Address - Country:US
Practice Address - Phone:507-416-7158
Practice Address - Fax:850-204-0489
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist