Provider Demographics
NPI:1821661604
Name:TAYLOR, TARYN RAEANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:RAEANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:RAEANN
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 S JASMINE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7708
Mailing Address - Country:US
Mailing Address - Phone:918-961-8283
Mailing Address - Fax:
Practice Address - Street 1:1275 S JASMINE LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7708
Practice Address - Country:US
Practice Address - Phone:918-961-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2960235Z00000X
FLSA19840235Z00000X
AR201596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty