MEDICARE: MACEY TAYLOR VAN SAVAGE

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	30001135	NC

General Provider Information

NPI Number	:	1235825480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACEY TAYLOR VAN SAVAGE

Provider Business Mailing Address
First Line	:	7125 WINTER POND WAY
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-5486
Country	:	US
Telephone Number	:	919-348-9174
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 WINTER POND WAY
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-5486
Country	:	US
Telephone Number	:	919-348-9174
Fax Number	:

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

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	04/12/2023

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