Healthcare Provider Details

I. General information

NPI: 1548184302
Provider Name (Legal Business Name): BROOKLYN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11589 STATE ROUTE 81
DOLA OH
45835-9706
US

IV. Provider business mailing address

2190 MIAMI CONSERVANCY RD
SIDNEY OH
45365-9518
US

V. Phone/Fax

Practice location:
  • Phone: 419-759-2331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20263480-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: