MEDICARE: PROF. YOLONDE RENEE TAYLOR M.S., SLP-CCC

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	003243	GA

General Provider Information

NPI Number	:	1760546055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. YOLONDE RENEE TAYLOR M.S., SLP-CCC

Provider Business Mailing Address
First Line	:	625 SPRING CREEK LN
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-4947
Country	:	US
Telephone Number	:	706-294-7778
Fax Number	:	706-854-1641

Provider Business Practice Location Address
First Line	:	625 SPRING CREEK LN
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-4947
Country	:	US
Telephone Number	:	706-294-7778
Fax Number	:	706-854-1641

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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