Provider Demographics
NPI:1245709096
Name:CREECH, TAYLOR N (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:N
Last Name:CREECH
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 1:1015 PRINCEWOOD AVE APT C
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5875
Mailing Address - Country:US
Mailing Address - Phone:937-829-5633
Mailing Address - Fax:
Practice Address - Street 1:5070 LAMME RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-3266
Practice Address - Country:US
Practice Address - Phone:937-293-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist