Healthcare Provider Details

I. General information

NPI: 1619706744
Provider Name (Legal Business Name): TAYLOR SEGO SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N WALTON BLVD STE 2&4
BENTONVILLE AR
72712-4548
US

IV. Provider business mailing address

701 N WALTON BLVD STE 2&4
BENTONVILLE AR
72712-4548
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-9838
  • Fax:
Mailing address:
  • Phone: 479-250-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number202870
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: