Provider Demographics
NPI:1457535304
Name:TAYLOR, CARL B (MA-CCC/A)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MA-CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 WYOMING BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6020
Mailing Address - Country:US
Mailing Address - Phone:505-821-6715
Mailing Address - Fax:505-821-0839
Practice Address - Street 1:7920 WYOMING BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6020
Practice Address - Country:US
Practice Address - Phone:505-821-6715
Practice Address - Fax:505-821-0839
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4524237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter