MEDICARE: KIMBERLY ANN TAYLOR MS, CCC- 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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1316227630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN TAYLOR MS, CCC- SLP

Provider Business Mailing Address
First Line	:	4269 APACHE PLUME DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7637
Country	:	US
Telephone Number	:	719-233-1743
Fax Number	:	719-465-1966

Provider Business Practice Location Address
First Line	:	4269 APACHE PLUME DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7637
Country	:	US
Telephone Number	:	719-233-1743
Fax Number	:	719-465-1966

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

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	04/26/2013

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