Provider Demographics
NPI:1679854301
Name:TAYLOR, ANGELA ATCHESON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ATCHESON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 TURNER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5723
Mailing Address - Country:US
Mailing Address - Phone:321-622-8792
Mailing Address - Fax:321-622-8793
Practice Address - Street 1:7145 TURNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5721
Practice Address - Country:US
Practice Address - Phone:321-622-8792
Practice Address - Fax:321-622-8793
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist