Healthcare Provider Details

I. General information

NPI: 1144914797
Provider Name (Legal Business Name): TABATHA TAYLOR MS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 W MAIN ST
FARMINGTON AR
72730-2946
US

IV. Provider business mailing address

49 OLD DEPOT RD
FARMINGTON AR
72730-2932
US

V. Phone/Fax

Practice location:
  • Phone: 479-206-8206
  • Fax: 479-206-8206
Mailing address:
  • Phone: 479-206-8206
  • Fax: 833-873-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number202229
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: