Provider Demographics
NPI:1659772945
Name:TAYLOR, SUSAN ROSE (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ROSE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E CARTER ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3208
Mailing Address - Country:US
Mailing Address - Phone:704-880-6304
Mailing Address - Fax:
Practice Address - Street 1:214 E CARTER ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3208
Practice Address - Country:US
Practice Address - Phone:704-880-6304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist