Provider Demographics
NPI:1740595289
Name:TAYLOR, STACY LEIGH (SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEIGH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 CASA ROJA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6587
Mailing Address - Country:US
Mailing Address - Phone:505-250-7594
Mailing Address - Fax:
Practice Address - Street 1:1008 CASA ROJA PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6587
Practice Address - Country:US
Practice Address - Phone:505-250-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist