Provider Demographics
NPI:1629760335
Name:BOWERS, TAYLOR BREANNE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BREANNE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 MAY BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6397
Mailing Address - Country:US
Mailing Address - Phone:901-687-8024
Mailing Address - Fax:
Practice Address - Street 1:6952 DOGWOOD MNR N STE 101
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2091
Practice Address - Country:US
Practice Address - Phone:662-932-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist