Provider Demographics
NPI:1932418340
Name:TAYLOR, MARVIN WESLEY (MS, SLP)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:WESLEY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19425 HAVEN WHITE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-4982
Mailing Address - Country:US
Mailing Address - Phone:954-600-0407
Mailing Address - Fax:
Practice Address - Street 1:12 S SUMMIT AVE STE 100
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2090
Practice Address - Country:US
Practice Address - Phone:202-556-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-03
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4828235Z00000X
MD08704235Z00000X
VA2202010014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist