Healthcare Provider Details

I. General information

NPI: 1497317432
Provider Name (Legal Business Name): TAYLOR JO ROONEY MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 03/26/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

IV. Provider business mailing address

5021 HAYGOOD RD
VIRGINIA BEACH VA
23455-5205
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3951
  • Fax:
Mailing address:
  • Phone: 320-309-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204000314
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: