Provider Demographics
NPI:1801155692
Name:ANGELA ATCHESON TAYLOR LLC
Entity type:Organization
Organization Name:ANGELA ATCHESON TAYLOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ATCHESON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:321-241-4816
Mailing Address - Street 1:7145 TURNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5721
Mailing Address - Country:US
Mailing Address - Phone:321-241-4816
Mailing Address - Fax:321-241-4817
Practice Address - Street 1:7145 TURNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5721
Practice Address - Country:US
Practice Address - Phone:321-241-4816
Practice Address - Fax:321-241-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty