MEDICARE: NICOLE TAYLOR CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	114999	TX

General Provider Information

NPI Number	:	1578228011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE TAYLOR CCC-SLP

Provider Business Mailing Address
First Line	:	2114 SAVANNA CT S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5040
Country	:	US
Telephone Number	:	346-664-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 SAVANNA CT S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5040
Country	:	US
Telephone Number	:	346-664-1843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2021
Last Update Date	:	05/13/2026

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Directions to “ NICOLE TAYLOR CCC-SLP” Practice Location

Language	Start Address	Practice Location

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