MEDICARE: TAYLOR JEAN EGET M.ED.

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	21288	FL

General Provider Information

NPI Number	:	1245910637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR JEAN EGET M.ED.

Provider Business Mailing Address
First Line	:	1514 N DAYTONA AVE
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-2909
Country	:	US
Telephone Number	:	770-712-8414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 N DAYTONA AVE
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-2909
Country	:	US
Telephone Number	:	770-712-8414
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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Directions to “ TAYLOR JEAN EGET M.ED.” Practice Location

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