Provider Demographics
NPI:1811014046
Name:TAYLOR, HOLLY L (SLP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
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 1:137 WINCKLES ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6151
Mailing Address - Country:US
Mailing Address - Phone:440-366-5993
Mailing Address - Fax:440-366-5313
Practice Address - Street 1:137 WINCKLES ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6151
Practice Address - Country:US
Practice Address - Phone:440-366-5993
Practice Address - Fax:440-366-5313
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341490517043OtherCARESOURCE
OH654140OtherAETNA
OH2167462Medicaid
OH000000354649OtherANTHEM BLUE CROSS
OH341490517043OtherCARESOURCE