1306925730 NPI number — KENYA H TAYLOR MSP, CCC-SLP

Table of content: KENYA H TAYLOR MSP, CCC-SLP (NPI 1306925730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306925730 NPI number — KENYA H TAYLOR MSP, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
KENYA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSP, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306925730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 AUGUSTA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29605-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-370-9478
Provider Business Mailing Address Fax Number:
864-370-9478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 W CURTIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29681-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-967-7191
Provider Business Practice Location Address Fax Number:
864-228-0334
Provider Enumeration Date:
11/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2067 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)