Provider Demographics
NPI:1255766499
Name:TAYLOR, NICOLE ELIZABETH (AUD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:HELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-8903
Mailing Address - Fax:313-966-2694
Practice Address - Street 1:3901 BEAUBIEN BLVD.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-8903
Practice Address - Fax:313-966-2694
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI160100621231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist