Healthcare Provider Details

I. General information

NPI: 1144144254
Provider Name (Legal Business Name): CASEY TAYLOR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W BROADWAY
ANAHEIM CA
92802-1107
US

IV. Provider business mailing address

14430 MULBERRY DR APT 140
WHITTIER CA
90604-1336
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-8932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: