Provider Demographics
NPI:1295550812
Name:DAUGHERTY, TAYLOR LAUREN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAUREN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LAUREN
Other - Last Name:FEDERSPILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4455 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2504
Mailing Address - Country:US
Mailing Address - Phone:414-427-5370
Mailing Address - Fax:
Practice Address - Street 1:4455 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2504
Practice Address - Country:US
Practice Address - Phone:414-427-5370
Practice Address - Fax:414-307-1853
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist