MEDICARE: TAYLOR JORDYN ROHM

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
1	235Z00000X	Speech-Language Pathologist	8394	SC

General Provider Information

NPI Number	:	1134803000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR JORDYN ROHM

Provider Business Mailing Address
First Line	:	1524 GARDENSIDE CT
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-0361
Country	:	US
Telephone Number	:	630-523-4986
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 PRATHER PARK DR UNIT B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7983
Country	:	US
Telephone Number	:	843-640-5522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	12/17/2024

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Directions to “ TAYLOR JORDYN ROHM ” Practice Location

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