Healthcare Provider Details

I. General information

NPI: 1134803000
Provider Name (Legal Business Name): TAYLOR JORDYN ROHM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PRATHER PARK DR UNIT B
MYRTLE BEACH SC
29588-7983
US

IV. Provider business mailing address

1524 GARDENSIDE CT
NAPERVILLE IL
60540-0361
US

V. Phone/Fax

Practice location:
  • Phone: 843-640-5522
  • Fax:
Mailing address:
  • Phone: 630-523-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8394
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: