Provider Demographics
NPI:1922745322
Name:TAYLOR, JESSICA YVETTE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:YVETTE
Last Name:TAYLOR
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 1:1109 E HEBRON PKWY APT 15202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1331
Mailing Address - Country:US
Mailing Address - Phone:469-315-3848
Mailing Address - Fax:
Practice Address - Street 1:1109 E HEBRON PKWY APT 15202
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1331
Practice Address - Country:US
Practice Address - Phone:469-315-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX424312355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant