Provider Demographics
NPI:1982349064
Name:RODERICK, TAYLOR MARIA
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIA
Last Name:RODERICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02718-1021
Mailing Address - Country:US
Mailing Address - Phone:508-431-6005
Mailing Address - Fax:
Practice Address - Street 1:800 TECHNOLOGY CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4721
Practice Address - Country:US
Practice Address - Phone:781-290-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant