Provider Demographics
NPI:1710510516
Name:SAFSTROM, TAYLOR MORGAN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MORGAN
Last Name:SAFSTROM
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 1:120 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-1345
Mailing Address - Country:US
Mailing Address - Phone:715-570-1714
Mailing Address - Fax:
Practice Address - Street 1:765 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2325
Practice Address - Country:US
Practice Address - Phone:910-738-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist