Provider Demographics
NPI:1669216487
Name:TAYLOR, ANSLEY NICOLE (MED)
Entity type:Individual
Prefix:MISS
First Name:ANSLEY
Middle Name:NICOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 E BROAD ST APT 203
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2817
Mailing Address - Country:US
Mailing Address - Phone:770-331-0241
Mailing Address - Fax:
Practice Address - Street 1:367 CLEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4173
Practice Address - Country:US
Practice Address - Phone:706-356-7450
Practice Address - Fax:706-356-7451
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET004009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist