Provider Demographics
NPI:1790360576
Name:MCDONALD, TAYLOR LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:LYNN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 N LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-9834
Mailing Address - Country:US
Mailing Address - Phone:304-813-7628
Mailing Address - Fax:
Practice Address - Street 1:135 SOUTHERN DR
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2010
Practice Address - Country:US
Practice Address - Phone:304-788-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
WV1960235Z00000X
MD09108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist