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NPI Code Detail

MEDICARE: MISTYLEE B TAYLOR SLP

MEDICARE: MISTYLEE B TAYLOR SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist22004150AIN

General Provider Information

NPI Number : 1063632081
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTYLEE B TAYLOR SLP
Provider Business Mailing Address
First Line : 216 KITTRIDGE LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9576
Country : US
Telephone Number : 260-338-1241
Fax Number :
Provider Business Practice Location Address
First Line : 808 MILL LAKE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-6400
Country : US
Telephone Number : 260-338-1241
Fax Number : 260-338-1231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/09/2007

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Directions to “ MISTYLEE B TAYLOR SLP” Practice Location

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