Healthcare Provider Details

I. General information

NPI: 1457878837
Provider Name (Legal Business Name): TAYLOR SAEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 JEFFERSON ST
NEW BOSTON IL
61272-8636
US

IV. Provider business mailing address

5822 93RD AVE W
TAYLOR RIDGE IL
61284-9510
US

V. Phone/Fax

Practice location:
  • Phone: 309-587-8141
  • Fax:
Mailing address:
  • Phone: 309-714-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2017099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: