Healthcare Provider Details

I. General information

NPI: 1417875683
Provider Name (Legal Business Name): DYLAN R TRAYLOR SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N MAIN ST
PICAYUNE MS
39466-3313
US

IV. Provider business mailing address

317 N MAIN ST
PICAYUNE MS
39466-3313
US

V. Phone/Fax

Practice location:
  • Phone: 769-926-2441
  • Fax: 769-926-2442
Mailing address:
  • Phone: 769-926-2441
  • Fax: 769-926-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS5526
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: