Provider Demographics
NPI:1619249752
Name:TAYLOR, JACQUELINE YVETTE (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:YVETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:YVETTE
Other - Last Name:CLAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 S DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3234
Mailing Address - Country:US
Mailing Address - Phone:269-343-1296
Mailing Address - Fax:269-344-8485
Practice Address - Street 1:501 S DRAKE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3234
Practice Address - Country:US
Practice Address - Phone:269-343-1296
Practice Address - Fax:269-344-8485
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000603231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist