Healthcare Provider Details

I. General information

NPI: 1417886458
Provider Name (Legal Business Name): MARISSABETH TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 S LASPINA ST
TULARE CA
93274-6962
US

IV. Provider business mailing address

600 N CHERRY ST
TULARE CA
93274-2978
US

V. Phone/Fax

Practice location:
  • Phone: 559-685-7290
  • Fax:
Mailing address:
  • Phone: 559-685-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: