Provider Demographics
NPI:1922622018
Name:TAYLOR, AMELIA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 HOLMES ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-1375
Mailing Address - Country:US
Mailing Address - Phone:316-734-5124
Mailing Address - Fax:
Practice Address - Street 1:6910 N HOLMES ST STE 200
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-2666
Practice Address - Country:US
Practice Address - Phone:816-804-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020005240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist