Healthcare Provider Details

I. General information

NPI: 1902306319
Provider Name (Legal Business Name): DAVACHE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 DIEHL RD
WARRENVILLE IL
60555-3849
US

IV. Provider business mailing address

2200 CHERRY LN APT 316
LISLE IL
60532-1183
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-6533
  • Fax:
Mailing address:
  • Phone: 708-335-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-25678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: