Healthcare Provider Details

I. General information

NPI: 1306675244
Provider Name (Legal Business Name): TAYLOR WREN WILLIS MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 MENDENHALL OAKS PKWY STE 103
HIGH POINT NC
27265-8414
US

IV. Provider business mailing address

4144 MENDENHALL OAKS PKWY STE 103
HIGH POINT NC
27265-8414
US

V. Phone/Fax

Practice location:
  • Phone: 336-601-8604
  • Fax:
Mailing address:
  • Phone: 336-601-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30003033
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: