Healthcare Provider Details

I. General information

NPI: 1417344482
Provider Name (Legal Business Name): LACY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INNWOOD CIR STE A
LITTLE ROCK AR
72211-2490
US

IV. Provider business mailing address

1401 SCOTT ST 302
LITTLE ROCK AR
72202-5080
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-8075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#P800
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: