Provider Demographics
NPI:1770881773
Name:TAYLOR, BROOKE D (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11908 OLD CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7118
Mailing Address - Country:US
Mailing Address - Phone:919-815-0087
Mailing Address - Fax:
Practice Address - Street 1:11908 OLD CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-7118
Practice Address - Country:US
Practice Address - Phone:919-815-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist