Provider Demographics
NPI:1861045809
Name:HALLENBECK, TAYLOR KATHRYN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KATHRYN
Last Name:HALLENBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 BONITA HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4629
Mailing Address - Country:US
Mailing Address - Phone:706-550-9008
Mailing Address - Fax:
Practice Address - Street 1:198 BONITA HILLS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-4629
Practice Address - Country:US
Practice Address - Phone:706-550-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program