Provider Demographics
NPI:1821751793
Name:GILCREASE, TAYLOR ANN (SLP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:GILCREASE
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 1:51 ISAAC LN
Mailing Address - Street 2:
Mailing Address - City:HUMPHREY
Mailing Address - State:AR
Mailing Address - Zip Code:72073-9641
Mailing Address - Country:US
Mailing Address - Phone:870-659-6233
Mailing Address - Fax:
Practice Address - Street 1:1699 RED WOLF BLVD STE H
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5453
Practice Address - Country:US
Practice Address - Phone:870-659-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist