Provider Demographics
NPI:1356020929
Name:LEUPOLD, TAYLOR NICOLE-MINDY
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE-MINDY
Last Name:LEUPOLD
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 1:129 N TRADD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5239
Mailing Address - Country:US
Mailing Address - Phone:704-380-0799
Mailing Address - Fax:704-278-0146
Practice Address - Street 1:129 N TRADD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5239
Practice Address - Country:US
Practice Address - Phone:704-380-0799
Practice Address - Fax:704-278-0146
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist